The International Union Against Tuberculosis and Lung Disease, 75006, Paris, France.
Lighthouse Trust, Box 106, Lilongwe, Malawi.
Trans R Soc Trop Med Hyg. 2020 Jan 6;114(1):31-37. doi: 10.1093/trstmh/trz087.
As routine viral load testing among HIV-infected individuals on antiretroviral therapy (ART) expands, virologic failure (VF) among children in developing countries remains poorly understood. We assessed the rate of VF, the proportion failing who were subsequently switched to second-line ART and factors associated with VF among children ≤18 y.
An observation cohort study among 1312 children at two public clinics in Lilongwe, Malawi who initiated a first-line ART regimen between January 2014 and December 2017 and remained on treatment for ≥6 mo was conducted. Kaplan-Meier methods estimated the probabilities of VF. Univariable and multivariable Poisson regression models were used to explore predictors of VF.
Overall, 16% (208/1312) of children experienced VF with an incidence rate of 10.1 events per 100 person-years. Of the 208, 184 (88%) were switched to second-line ART: 68 (43%) switched the same day VF was confirmed and 106 (66%) switched within 90 d of confirmed VF. Use of a Nevirapine (NVP)-based regimen and initiating ART in 2016-2017 compared with 2014-2015 were independent predictors of VF.
VF is common among children receiving ART. The findings suggest that VF can be reduced by phasing out NVP-based regimen and by ensuring optimal adherence to ART.
随着接受抗逆转录病毒疗法（ART）的艾滋病毒感染者常规进行病毒载量检测，发展中国家儿童的病毒学失败（VF）仍然知之甚少。我们评估了≤18 岁儿童 VF 的发生率、随后转为二线 ART 的失败比例以及与 VF 相关的因素。
我们开展了一项观察性队列研究，在马拉维利隆圭的两家公立诊所中，共有 1312 名于 2014 年 1 月至 2017 年 12 月期间开始一线 ART 方案且治疗持续时间≥6 个月的儿童参与了该研究。Kaplan-Meier 方法估计了 VF 的概率。采用单变量和多变量 Poisson 回归模型来探讨 VF 的预测因素。
总体而言，16%（208/1312）的儿童发生了 VF，VF 的发生率为每 100 人年 10.1 例。在这 208 例中，184 例（88%）转为二线 ART：68 例（43%）在 VF 确诊当天转换，106 例（66%）在 VF 确诊后 90 天内转换。使用奈韦拉平（NVP）为基础的方案和 2016-2017 年开始 ART 与 2014-2015 年相比是 VF 的独立预测因素。
在接受 ART 的儿童中，VF 很常见。研究结果表明，通过淘汰 NVP 为基础的方案并确保 ART 最佳依从性，可以降低 VF。
