From the Department of Pediatrics, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia.
School of Medicine.
Pediatr Infect Dis J. 2021 Jan;40(1):60-65. doi: 10.1097/INF.0000000000002898.
Optimal care for children with HIV infection includes timely assessment of treatment failure. Using HIV viral load to define treatment failure remains a challenge in resource-limited settings.
Children with HIV infection who were already on or starting first-line antiretroviral therapy were enrolled and followed over time. We examined clinical and immunologic predictors of virologic failure (VF), defined as consecutive viral load measurements > 1000 copies/mL (VF). Children were followed every 6 months with clinical assessments, immunologic assays and viral load testing until treatment failure or up to 18 months.
Of the 484 children with complete data, we observed a prevalence of 15% who had VF at enrollment, and 18 who developed VF over 10.5 person-years of follow-up for an incidence of 4.97 [95% CI: 3.04-7.70) per 100 person-years. Lower adherence, lower CD4 T-cell count, lower white blood cells count, lower platelets and a lower glomerular filtration rate were all associated with increased VF. However, in a multivariable analysis, renal function (estimated glomerular filtration rate < 90 mL/min), odds ratio: 11.5 (95% CI: 1.5-63.7), and lower adherence, odds ratio: 3.9 (95% CI: 1.1-13.4), were the only factors associated with development of VF.
We identified a significant risk of VF in children with HIV infection in a prospective cohort study in southern Ethiopia and limited predictive value of clinical variables for VF. This provides further evidence that rapid and reliable viral load testing is needed to adequately address the HIV epidemic, along with implementation of adherence interventions in sub-Saharan Africa.
对 HIV 感染儿童进行最佳治疗包括及时评估治疗失败。在资源有限的环境中，使用 HIV 病毒载量来定义治疗失败仍然具有挑战性。
已开始或正在接受一线抗逆转录病毒治疗的 HIV 感染儿童被纳入并进行随访。我们检查了临床和免疫预测因素与病毒学失败（VF）的相关性，VF 定义为连续病毒载量测量值> 1000 拷贝/ml（VF）。儿童每 6 个月进行一次临床评估、免疫检测和病毒载量检测，直到治疗失败或随访 18 个月。
在 484 名有完整数据的儿童中，我们观察到 15%的儿童在入组时发生 VF，在 10.5 年的随访中有 18 名儿童发生 VF，发病率为每 100 人年 4.97（95%可信区间：3.04-7.70）。较低的依从性、较低的 CD4 细胞计数、较低的白细胞计数、较低的血小板计数和较低的肾小球滤过率均与 VF 增加相关。然而，在多变量分析中，肾功能（估计肾小球滤过率<90 ml/min），比值比：11.5（95%可信区间：1.5-63.7），以及较低的依从性，比值比：3.9（95%可信区间：1.1-13.4），是与 VF 发展相关的唯一因素。
我们在埃塞俄比亚南部的一项前瞻性队列研究中发现 HIV 感染儿童 VF 的风险显著，并发现临床变量对 VF 的预测价值有限。这进一步证明，在撒哈拉以南非洲，需要快速可靠的病毒载量检测来充分应对 HIV 流行，同时还需要实施依从性干预措施。
