Department of Medicine, Indiana University, Indianapolis, IN, USA.
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
J Int AIDS Soc. 2019 Apr;22(4):e25272. doi: 10.1002/jia2.25272.
Despite the central role of caregivers in managing HIV treatment for children living with HIV, viral suppression within caregiver-child dyads in which both members are living with HIV is not well described.
We conducted a retrospective analysis of children living with HIV <15 years of age and their caregivers living with HIV attending HIV clinics affiliated with the Academic Model Providing Access to Healthcare (AMPATH) in Kenya between 2015 and 2017. To be included in the analysis, children and caregivers must have had ≥1 viral load (VL) during the study period while receiving antiretroviral therapy (ART) for ≥6 months, and the date of the caregiver's VL must have occurred ±90 days from the date of the child's VL. The characteristics of children, caregivers and dyads were descriptively summarized. Multivariable logistic regression was used to estimate the odds of viral non-suppression (≥ 1000 copies/mL) in children, adjusting for caregiver and child characteristics.
Of 7667 children who received care at AMPATH during the study period, 1698 were linked to a caregiver living with HIV and included as caregiver-child dyads. For caregivers, 94% were mothers, median age at ART initiation 32.8 years, median CD4 count at ART initiation 164 cells/mm and 23% were not virally suppressed. For children, 52% were female, median age at ART initiation 4.2 years, median CD4 values at ART initiation were 15% (age < 5 years) and 396 cells/mm (age ≥ 5 years), and 38% were not virally suppressed. In the multivariable model, children were found more likely to not be virally suppressed if their caregivers were not suppressed compared to children with suppressed caregivers (aOR = 2.40, 95% CI: 1.86 to 3.10). Other characteristics associated with child viral non-suppression included caregiver ART regimen change prior to the VL, caregiver receipt of a non-NNRTI-based regimen at the time of the VL, younger child age at ART initiation and child tuberculosis treatment at the time of the VL.
Children were at higher risk of viral non-suppression if their caregivers were not virally suppressed compared to children with suppressed caregivers. A child's viral suppression status should be closely monitored if his or her caregiver is not suppressed.
尽管照顾者在管理儿童艾滋病毒感染者的治疗方面发挥着核心作用，但在照顾者-儿童二人组中，双方均为艾滋病毒感染者的病毒抑制情况并未得到很好的描述。
我们对 2015 年至 2017 年间在肯尼亚学术模式提供医疗保健机会（AMPATH）附属的艾滋病毒诊所接受艾滋病毒治疗的 15 岁以下艾滋病毒感染者儿童及其艾滋病毒感染者照顾者进行了回顾性分析。为了纳入分析，儿童和照顾者在接受抗逆转录病毒治疗（ART）≥6 个月期间必须至少有 1 次病毒载量（VL），且照顾者的 VL 日期必须在儿童 VL 日期的±90 天内。对儿童、照顾者和二人组的特征进行描述性总结。使用多变量逻辑回归估计儿童病毒未抑制（≥1000 拷贝/毫升）的几率，调整照顾者和儿童特征。
在研究期间在 AMPATH 接受护理的 7667 名儿童中，有 1698 名与艾滋病毒感染者照顾者相关联，并被纳入照顾者-儿童二人组。对于照顾者，94%是母亲，开始接受抗逆转录病毒治疗的中位年龄为 32.8 岁，开始接受抗逆转录病毒治疗的中位 CD4 计数为 164 个细胞/立方毫米，23%未被病毒抑制。对于儿童，52%是女性，开始接受抗逆转录病毒治疗的中位年龄为 4.2 岁，开始接受抗逆转录病毒治疗的中位 CD4 值为 15%（年龄<5 岁）和 396 个细胞/立方毫米（年龄≥5 岁），38%未被病毒抑制。在多变量模型中，与 CD4 抑制的照顾者相比，未被 CD4 抑制的照顾者的儿童更有可能未被病毒抑制（调整后的比值比[aOR]为 2.40，95%置信区间：1.86 至 3.10）。与儿童病毒未抑制相关的其他特征包括 VL 前照顾者 ART 方案改变、VL 时照顾者接受非非核苷类逆转录酶抑制剂方案、儿童 ART 起始年龄较小和 VL 时儿童结核病治疗。
与 CD4 抑制的照顾者相比，未被 CD4 抑制的照顾者的儿童更有可能未被病毒抑制。如果他或她的照顾者未被抑制，应密切监测儿童的病毒抑制状态。
