接受抗逆转录病毒治疗≥10年的围产期感染HIV阳性青少年和青年的治疗结果。

Treatment outcomes in perinatally infected HIV-positive adolescents and young adults after ≥10 years on antiretroviral therapy.

作者信息

Anderson K, Muloiwa R, Davies M-A

机构信息

Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, South Africa.

出版信息

S Afr Med J. 2018 Dec 13;109(1):27-34. doi: 10.7196/SAMJ.2018.v109i1.13230.

DOI:10.7196/SAMJ.2018.v109i1.13230

PMID:30606301

Abstract

BACKGROUND

The burden of paediatric HIV in South Africa has shifted to older children and adolescents. Nevertheless, information on long-term treatment outcomes of perinatally HIV-infected (PHIV) children is limited.

OBJECTIVES

To examine long-term immunological and virological outcomes of children who were in care for at least 10 years after starting antiretroviral therapy (ART).

METHODS

We performed a retrospective cohort study of 127 PHIV children who initiated ART at a Cape Town clinic between 2002 and 2005 and were followed up for ≥10 years from the ART initiation date. CD4+ counts and viral loads (VLs) were analysed for each successive year on ART. Treatment history, resistance test results, growth data, hospital admissions and opportunistic infection history were described.

RESULTS

The median age at ART initiation was 2.6 years (interquartile range (IQR) 1.3 - 4.9) and the median CD4+ percentage 13.0% (IQR 8.9 - 18.0). The first ART regimen was non-nucleoside reverse transcriptase inhibitor based (63.8%) or protease inhibitor based (36.2%). Median follow-up was 12.2 years (IQR 11.1 - 13.0). At the last assessment, 49.6% of patients were on first-line and 43.3% on second-line ART. At the last assessment, the median CD4+ count was 686 cells/µL (IQR 545 - 859) and 78.7% of children had CD4+ counts >500 cells/µL (92.1% of those on first-line v. 70.9% on second-line ART; p=0.003). At the last assessment, 79.5% of patients were virally suppressed (VL <400 copies/mL), 86.2% of those on first-line v. 76.8% on second-line ART (p=0.183). The 10-year probability of experiencing viral failure (VF) was 56.7% (95% confidence interval (CI) 48.3 - 65.5) and the 10-year probability of switching to second-line ART 45.7% (95% CI 37.5 - 54.8). The probability of experiencing VF between the ages of 10 and 18 years was 37.4% (95% CI 25.4 - 52.8).

CONCLUSIONS

Virological and immunological outcomes were good overall in PHIV children who remained in care for ≥10 years at this clinic, but >40% of children were on second-line ART with poorer immunological outcomes.

摘要

背景

南非儿童艾滋病毒负担已转移至年龄较大的儿童和青少年。然而，关于围产期感染艾滋病毒（PHIV）儿童的长期治疗结果的信息有限。

目的

研究开始抗逆转录病毒治疗（ART）后接受治疗至少10年的儿童的长期免疫和病毒学结果。

方法

我们对127名PHIV儿童进行了一项回顾性队列研究，这些儿童于2002年至2005年在开普敦一家诊所开始接受ART治疗，并从ART开始日期起随访≥10年。对接受ART治疗的每一年连续分析CD4 +细胞计数和病毒载量（VLs）。描述了治疗史、耐药测试结果、生长数据、住院情况和机会性感染史。

结果

开始ART治疗的中位年龄为2.6岁（四分位间距（IQR）1.3 - 4.9），CD4 +百分比中位数为13.0%（IQR 8.9 - 18.0）。第一个ART方案是以非核苷类逆转录酶抑制剂为基础（63.8%）或以蛋白酶抑制剂为基础（36.2%）。中位随访时间为12.2年（IQR 11.1 - 13.0）。在最后一次评估时，49.6%的患者接受一线ART治疗，43.3%接受二线ART治疗。在最后一次评估时，CD4 +细胞计数中位数为686个细胞/μL（IQR 545 - 859），78.7%的儿童CD4 +细胞计数>500个细胞/μL（一线治疗的儿童中92.1%，二线ART治疗的儿童中70.9%；p = 0.003）。在最后一次评估时，79.5%的患者病毒得到抑制（VL <400拷贝/mL），一线治疗的患者中86.2%，二线ART治疗的患者中76.8%（p = 0.183）。发生病毒学失败（VF）的10年概率为56.7%（95%置信区间（CI）48.3 - 65.5），转换至二线ART治疗的10年概率为45.7%（95% CI 37.5 - 54.8）。10至18岁之间发生VF的概率为37.4%（95% CI 25.4 - 52.8）。