HIV Department, World Health Organization, Geneva, Switzerland.
ICAP at Columbia University, New York, NY.
J Acquir Immune Defic Syndr. 2018 Aug 15;78 Suppl 2:S128-S133. doi: 10.1097/QAI.0000000000001738.
In August 2014, PEPFAR and the Children's Investment Fund Foundation launched the Accelerating Children's HIV/AIDS Treatment (ACT) initiative with the aim of doubling the number of children on antiretroviral treatment in 9 African countries. Increasing rates of pretreatment drug resistance and use of suboptimal treatment regimens and formulations result in poor adherence and high rates of viral failure. Supporting adherence and ensuring appropriate treatment monitoring are needed to maximize duration of first-line treatment and enable timely sequencing to subsequent lines of antiretroviral treatment. Although timely antiretroviral treatment is the core of clinical care for infants, children and adolescents living with HIV, ensuring a broader package of biomedical and non-biomedical interventions is also required to address highly prevalent comorbidities among children living with HIV. Providing such a comprehensive package has been challenging for health care workers who lack the necessary skills and confidence to care for pediatric populations. Efforts to simplify clinical management and specific training and mentorship are needed to address these challenges. In this article, we review the progress made during the ACT initiative and the persistent challenges in achieving and maintaining virological suppression across the age spectrum. We identify innovations needed to build on the success of the ACT initiative. Despite the challenges, achieving high levels of virological suppression in children and adolescents is possible. The complexity of pediatric HIV treatment can be offset as antiretroviral regimens become more effective, tolerable, and easier to prescribe and administer. Meanwhile, basic programmatic elements to address comorbidities as well as support health care workers remain critical. In this article we review the progress made through the ACT initiative, as well as identify innovations needed to address persistent challenges to viral suppression across the age spectrum.
2014 年 8 月，PEPFAR 和儿童投资基金会基金会启动了加速儿童艾滋病治疗（ACT）倡议，旨在将 9 个非洲国家接受抗逆转录病毒治疗的儿童人数增加一倍。预处理耐药率的增加以及使用不太理想的治疗方案和配方导致了较差的依从性和高病毒失败率。需要支持依从性并确保进行适当的治疗监测，以最大限度地延长一线治疗的持续时间，并能够及时进行后续抗逆转录病毒治疗方案的测序。尽管及时进行抗逆转录病毒治疗是艾滋病毒感染婴儿、儿童和青少年临床护理的核心，但为了解决艾滋病毒感染儿童中普遍存在的合并症，还需要确保更广泛的生物医学和非生物医学干预措施。提供这样一个全面的方案对于缺乏必要技能和信心来照顾儿科人群的医疗保健工作者来说是具有挑战性的。需要努力简化临床管理以及特定的培训和指导，以应对这些挑战。在本文中，我们回顾了 ACT 倡议期间取得的进展以及在整个年龄范围内实现和维持病毒学抑制方面仍然存在的挑战。我们确定了需要创新的地方，以建立在 ACT 倡议的成功基础上。尽管存在挑战，但在儿童和青少年中实现高水平的病毒学抑制是可能的。随着抗逆转录病毒方案变得更加有效、可耐受且更容易开处方和管理，儿科 HIV 治疗的复杂性可以得到缓解。同时，解决合并症以及支持医疗保健工作者的基本方案要素仍然至关重要。在本文中，我们回顾了通过 ACT 倡议取得的进展，并确定了应对整个年龄范围内持续存在的病毒抑制挑战所需的创新。
