From the Department of Epidemiology, Milken Institute School of Public Health at the George Washington University, Washington, DC.
Division of Infectious Diseases, Children's National Medical Center, Washington, DC.
Pediatr Infect Dis J. 2020 May;39(5):421-428. doi: 10.1097/INF.0000000000002577.
Data on integrase strand transfer inhibitor (INSTI) use in children, adolescents and young adults with HIV are limited. We evaluated virologic and safety outcomes following INSTI initiation among treatment-experienced children, adolescents and young adults.
The DC Cohort is a multicenter observational study of individuals receiving HIV care in Washington, DC. This analysis included treatment-experienced participants 0-24 years of age who initiated an INSTI during 2011-2017. Viral suppression (VS) and safety outcomes were quantified. Differences in VS by age, sex and CD4 count were assessed using Kaplan-Meier curves.
Of 141 participants (median age 20 years; 35% <18 years; 60% male; 89% Black; 62% perinatally-infected), 35% had VS and 65% lacked VS on INSTI initiation. Dolutegravir was the most commonly prescribed INSTI (55%). Among participants without VS at INSTI initiation, 46% achieved VS after a median of 2.7 months. Participants 13-24 (vs. 0-12) years old (P = 0.011) and participants with CD4 counts <350 (vs. >500) cells/μL were less likely to achieve VS (P < 0.001). Among participants with VS at INSTI initiation, 51% sustained VS through a median of 11.0 months of follow-up; of the 49% with transient viremia, 77% later achieved VS again. There were no safety concerns associated with the use of INSTIs.
More than half of treatment-experienced children, adolescents and young adults with detectable viremia at INSTI initiation did not achieve VS, while half of those with prior VS experienced transient viremia. Further evaluation of long-term outcomes associated with INSTI use among children, adolescents and young adults is warranted.
关于整合酶抑制剂（INSTI）在 HIV 儿童、青少年和青年中的使用的数据有限。我们评估了在接受过治疗的儿童、青少年和青年中使用 INSTI 后的病毒学和安全性结果。
DC 队列是一项在华盛顿特区接受 HIV 护理的个体的多中心观察性研究。本分析包括在 2011-2017 年期间开始使用 INSTI 的 0-24 岁治疗经验丰富的参与者。使用 Kaplan-Meier 曲线评估病毒学抑制（VS）和安全性结果。使用 Kaplan-Meier 曲线评估年龄、性别和 CD4 计数对 VS 的差异。
在 141 名参与者（中位年龄 20 岁；35% <18 岁；60%男性；89%黑人；62%围产期感染）中，35%在开始 INSTI 时有 VS，65%没有 VS。度鲁特韦是最常用的 INSTI（55%）。在 INSTI 开始时没有 VS 的参与者中，46%在中位时间为 2.7 个月后达到 VS。13-24 岁（vs. 0-12 岁）（P=0.011）和 CD4 计数<350（vs. >500）细胞/μL 的参与者不太可能达到 VS（P<0.001）。在开始 INSTI 时有 VS 的参与者中，51%通过中位 11.0 个月的随访维持 VS；在 49%有一过性病毒血症的参与者中，77%后来再次达到 VS。使用 INSTI 没有出现安全性问题。
在 INSTI 开始时可检测到病毒血症的接受过治疗的儿童、青少年和青年中，超过一半的人没有达到 VS，而之前有 VS 的人中，有一半的人出现了一过性病毒血症。需要进一步评估 INSTI 在儿童、青少年和青年中的长期使用与相关的安全性问题。
