Service de pédiatrie Établissement Public de Santé (EPS) de Mbour, UFR Sciences de la Santé, Thiès University, Thiès, Senegal.
Expertise France, Paris, France.
BMC Pediatr. 2019 Feb 5;19(1):47. doi: 10.1186/s12887-019-1420-z.
In Senegal in 2015, an estimated 4800 children were living with HIV, with 1200 receiving ARV treatment, of whom half had follow-up care in decentralized sites outside Dakar. However, until now no studies have determined the efficacy of pediatric treatment in decentralized settings, even though the emergence of viral resistance, particularly among children in Africa, is a well-known phenomenon. This study aimed to assess the virological status of HIV-infected children in all decentralized facilities to help improve access to quality care.
A cross-sectional epidemiological and virological study was conducted in all of Senegal's regions, except Dakar, between March and June 2015 and sought to include all HIV-infected children and adolescents (0-19 years), treated or not with ARVs. Socio-demographic and clinical data and a blood sample on blotting paper were collected for children from treatment sites. Samples were routed on public transportation, assisted by a network of community health workers. A viral load (VL) assay was performed for each child, followed by genotyping when it exceeded 1000 copies/mL (3 log).
Of the 851 identified children, 666 (78%) were enrolled in the study. Half of the children were girls, and the average age was 8 years (6 months-19 years). Most of the children (96.7%) were infected with HIV-1, and 90% were treated with ART, primarily with AZT + 3TC + NVP/EFV therapeutic regimen. The median duration of time on ART was 21 months (1-129). VL was measured for 2% of children before this study. Almost two-thirds (64%) of the children are experiencing virological failure. Among them, there was resistance to at least one drug for 86.5% of cases. Also, 25% children presented resistance to one drug and 40% to two out of three. For nearly one-third of the children presenting resistance, none of the three drugs of the treatment was active. Factors associated with virological failure were male sex, follow-up by a generalist rather than a specialist, and treatment interruptions.
We observed a high level of virological failure and a high percentage of viral resistance among children receiving health care in decentralized facilities in Senegal.
2015 年在塞内加尔，约有 4800 名儿童感染艾滋病毒，其中 1200 名儿童接受抗逆转录病毒治疗，其中一半在达喀尔以外的非集中化场所接受后续护理。然而，尽管在非洲，儿童中出现病毒耐药性是一个众所周知的现象，但直到现在，还没有研究确定分散环境下儿科治疗的疗效。本研究旨在评估所有非集中化设施中感染艾滋病毒的儿童的病毒学状况，以帮助改善获得优质护理的机会。
2015 年 3 月至 6 月在塞内加尔除达喀尔以外的所有地区进行了一项横断面的流行病学和病毒学研究，旨在纳入所有接受或未接受抗逆转录病毒治疗的感染艾滋病毒的儿童和青少年（0-19 岁）。从治疗点收集儿童的社会人口学和临床数据以及血斑样本。样本通过公共交通工具运输，由社区卫生工作者网络协助。对每个孩子进行病毒载量（VL）检测，当 VL 超过 1000 拷贝/毫升（3 对数）时进行基因分型。
在确定的 851 名儿童中，有 666 名（78%）纳入研究。一半的儿童为女孩，平均年龄为 8 岁（6 个月-19 岁）。大多数儿童（96.7%）感染 HIV-1，90%接受 ART 治疗，主要采用 AZT+3TC+NVP/EFV 治疗方案。ART 治疗的中位时间为 21 个月（1-129）。在本研究之前，有 2%的儿童测量过 VL。近三分之二（64%）的儿童出现病毒学失败。其中，86.5%的病例至少对一种药物产生耐药性。此外，25%的儿童对一种药物耐药，40%的儿童对三种药物中的两种耐药。对于近三分之一出现耐药性的儿童，治疗方案中的三种药物均无活性。与病毒学失败相关的因素是男性、由全科医生而不是专家进行随访以及治疗中断。
我们观察到在塞内加尔非集中化场所接受卫生保健的儿童中，病毒学失败率很高，病毒耐药率也很高。
