多国儿童和青少年抗逆转录病毒疗法的长期处方：来自贝勒国际儿科艾滋病倡议在 6 个非洲国家的经验。
Multimonth Prescription of Antiretroviral Therapy Among Children and Adolescents: Experiences From the Baylor International Pediatric AIDS Initiative in 6 African Countries.
机构信息
Department of Pediatrics, Baylor International Pediatric AIDS Initiative, Houston, TX.
Baylor College of Medicine Abbott Fund Children's Clinical Centre of Excellence Malawi, Lilongwe, Malawi.
出版信息
J Acquir Immune Defic Syndr. 2018 Aug 15;78 Suppl 2(Suppl 2):S71-S80. doi: 10.1097/QAI.0000000000001730.
BACKGROUND
To reach 90-90-90 targets, differentiated approaches to care are necessary. We describe the experience of delivering multimonth prescription (MMP) schedules of antiretroviral therapy (ART) to youth at centers of excellence in 6 African countries.
METHODS
We analyzed data from electronic medical records of patients aged 0-19 years started on ART. Patients were eligible to transition from monthly prescribing to MMP when clinically stable [improving CD4, viral load (VL) suppression, or minimal HIV-associated morbidity] and ART adherent (pill count 95%-105%). Patients were classified as transitioned to MMP after 3 consecutive visits at intervals of >56 days. We used survival analysis to describe death and lost to follow-up. We described adherence and acceptable immunologic response by CD4 using 6-month and VL suppression (<400 copies per milliliter) using 12-month intervals.
RESULTS
Twenty-two thousand six hundred fifty-eight patients aged 0-19 years received ART and 14,932 (66%) transitioned to MMP between 2003 and 2015. Of these 2.6% were lost to follow-up and 2.0% died. Median duration of MMP was 3.9 (interquartile range: 2.2-5.9) years. There were significant differences in survival (P < 0.0001) between age groups, worst among those younger than 1 year and 15-19 years. The frequency of favorable clinical endpoints was high throughout the first 5 years of MMP, by year ranging from 87% to 94% acceptable immunologic response, 75% to 80% adherent, and 79% to 85% VL suppression.
CONCLUSIONS
These analyses from 6 African countries demonstrate that youth on ART who transitioned to MMP overall maintained favorable outcomes in terms of death, retention, adherence, immunosuppression, and viral suppression. These results reassure that children and adolescents, who are clinically stable and ART adherent, can do well with reduced visit frequencies and extended ART refills.
背景
为了实现 90-90-90 目标，需要采取有针对性的护理措施。我们描述了在 6 个非洲国家的卓越中心向青少年提供抗逆转录病毒治疗 (ART) 多剂量药物方案的经验。
方法
我们分析了电子病历中年龄在 0-19 岁之间开始接受 ART 的患者的数据。当患者临床状况稳定（CD4 改善、病毒载量 (VL) 抑制或最小的 HIV 相关发病率）且 ART 依从性良好（药物计数 95%-105%）时，他们有资格从每月处方过渡到多剂量药物方案。当患者在 >56 天的间隔内连续 3 次就诊时，将其归类为已过渡到多剂量药物方案。我们使用生存分析描述死亡和失访情况。我们使用 6 个月的 CD4 和 12 个月的 VL 抑制（<400 拷贝/毫升）来描述依从性和可接受的免疫反应。
结果
2003 年至 2015 年，22658 名 0-19 岁的患者接受了 ART 治疗，其中 14932 名（66%）过渡到多剂量药物方案。其中 2.6%失访，2.0%死亡。多剂量药物方案的中位持续时间为 3.9 年（四分位距：2.2-5.9）。在不同年龄组之间，生存情况存在显著差异（P < 0.0001），其中 1 岁以下和 15-19 岁之间的差异最大。在多剂量药物方案的前 5 年内，良好的临床终点的频率很高，可接受的免疫反应率为 87%至 94%，依从率为 75%至 80%，VL 抑制率为 79%至 85%。
结论
来自 6 个非洲国家的这些分析表明，总体而言，过渡到多剂量药物方案的接受 ART 治疗的青少年在死亡、保留、依从性、免疫抑制和病毒抑制方面保持了良好的结果。这些结果表明，对于临床稳定且 ART 依从性良好的儿童和青少年，减少就诊次数和延长 ART 续药时间可以取得良好的效果。
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