喀麦隆接受抗逆转录病毒治疗的成人、青少年和儿童的病毒抑制：在“检测即治疗”时代，青少年有较高的病毒学失败风险。

Viral suppression in adults, adolescents and children receiving antiretroviral therapy in Cameroon: adolescents at high risk of virological failure in the era of "test and treat".

机构信息

Chantal BIYA International Reference Centre for Research On HIV/AIDS Prevention and Management (CIRCB), Melen Road, PO BOX 3077, Yaounde, Cameroon.

Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon.

出版信息

AIDS Res Ther. 2019 Nov 19;16(1):36. doi: 10.1186/s12981-019-0252-0.

DOI:10.1186/s12981-019-0252-0

PMID:31744517

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6864925/

Abstract

BACKGROUND

After the launching of the « Test & Treat » strategy and the wider accessibility to viral load (VL), evaluating virological success (VS) would help in meeting the UNAIDS targets by 2020 in Cameroon.

SETTING AND METHODS

Cross-sectional study conducted in the Chantal BIYA International Reference Centre for research on HIV/AIDS prevention and management (CIRCB), Yaoundé, Cameroon; data generated between October 2016 and August 2017 amongst adults, adolescents and children at 12, 24, 36 and ≥ 48 months on ART. VS was defined as < 1000 copies/mL of blood plasma and controlled viremia as VL < 50 copies/mL. Data were analysed by SPSS; p < 0.05 considered as significant.

RESULTS

1946 patients (70% female) were enrolled (1800 adults, 105 adolescents, 41 children); 1841 were on NNRTI-based and 105 on PI-based therapy; with 346 patients at M12, 270 at M24, 205 at M36 and 1125 at ≥ M48. The median (IQR) duration on was 48 months (24-48). Overall, VS was 79.4% (95% CI 77.6-81.2) and 67.1% (95% CI 64.9-69.1) had controlled viral replication. On NNRTI-based, VS was 79.9% vs. 71.4% on PIs-based, p = 0.003. By ART duration, VS was 84.1% (M12), 85.9% (M24), 75.1% (M36) and 77.2% (≥ M48), p = 0.001. By age, VS was 75.6% (children), 53.3% (adolescents) and 81.1% (adults), p < 0.001.

CONCLUSIONS

In this sub-population of patients receiving ART in Cameroon, about 80% might be experiencing VS, with declining performance at adolescence, with NNRTI-based regimens, and as from 36 months on ART. Thus, improving VS may require an adapted adherence support mechanism, especially for adolescents with long-term treatment in resource-limited settings.

摘要

背景

在推出“检测即治疗”策略和更广泛地获得病毒载量（VL）之后，评估病毒学成功（VS）将有助于喀麦隆在 2020 年实现联合国艾滋病规划署的目标。

地点和方法

在雅温得的尚塔尔·比亚国际艾滋病毒/艾滋病预防和管理研究中心（CIRCB）进行了一项横断面研究；数据于 2016 年 10 月至 2017 年 8 月期间在接受抗逆转录病毒治疗（ART）的 12、24、36 和≥48 个月的成年人、青少年和儿童中生成。VS 定义为<1000 拷贝/ml 的血浆和 VL<50 拷贝/ml 的受控病毒血症。数据使用 SPSS 进行分析；p<0.05 被认为具有显著性。

结果

共纳入 1946 例患者（70%为女性）（1800 例成年患者、105 例青少年患者、41 例儿童患者）；1841 例患者接受基于 NNRTI 的治疗，105 例患者接受基于 PI 的治疗；其中 346 例患者在 M12，270 例患者在 M24，205 例患者在 M36，1125 例患者在≥M48。中位（IQR）治疗时间为 48 个月（24-48）。总体而言，VS 为 79.4%（95%CI 77.6-81.2），67.1%（95%CI 64.9-69.1）患者病毒复制得到控制。基于 NNRTI 的 VS 为 79.9%，而基于 PI 的 VS 为 71.4%，p=0.003。按 ART 持续时间，VS 分别为 M12 时的 84.1%、M24 时的 85.9%、M36 时的 75.1%和 M48 时的 77.2%，p=0.001。按年龄，VS 分别为儿童时的 75.6%、青少年时的 53.3%和成年时的 81.1%，p<0.001。