在埃塞俄比亚亚的斯亚贝巴的两家转诊医院中，接受二线抗逆转录病毒治疗的儿童和青少年的临床、免疫和病毒学结局。

Clinical, immunologic and virologic outcomes of children and adolescents receiving second line anti-retroviral therapy in two referral hospitals in Addis Ababa, Ethiopia.

机构信息

Sabiyan General Hospital, Dire Dawa, Ethiopia.

American Medical Center, Specialty Clinic for Infectious Diseases and Travel Medicine, Addis Ababa, Ethiopia.

出版信息

PLoS One. 2021 Mar 30;16(3):e0249085. doi: 10.1371/journal.pone.0249085. eCollection 2021.

BACKGROUND

Ethiopia launched free access for antiretroviral therapy in 2005. The number of patients on second line antiretroviral treatment has increased with each passing year. The objectives of this study were to describe the clinical, immunological and virologic outcomes of children and adolescents receiving second line anti-retroviral therapy in two referral hospitals, Yekatit 12 and Zewditu Memorial Hospitals, in Addis Ababa, Ethiopia.

METHODS

This was a hospital based retrospective cohort study conducted among children and adolescents aged 18 years and less and receiving a second line antiretroviral drugs. Data was collected using structured questionnaires. Means and percentages were used for nominal variables. Statistical analysis was made using statistical software-SPSS 23.0. Kaplan Meier analysis, long rank test and multivariate Cox proportion model were used to identify factors affecting survival.

RESULTS

A total of 75 children and adolescents were studied with a mean age of 13.28 years (SD: 4) with a mean treatment period on second line regimens of 35.2 months (SD: 21.8 months). Forty-eight participants were experiencing successful measures (in all three parameters) for their second line anti-retroviral treatment. Ten had virologic treatment failure while seven had died. Both treatment failure and death rates were higher within the first two years of treatment. Poor treatment adherence (Adjusted hazard ratio: 5.1 (95% CI: 1.1-23.2; p-value = 0.02)) and advanced World Health Organization clinical stage at start of the second line antiretrovirals (Adjusted hazard ratio: 7.51 (95% CI: 1.35-18.02; p-value = 0.002)) correlated significantly with survival of children and adolescents receiving treatment.

CONCLUSIONS

The study describes clinical, immunological and virologic outcomes of second line antiretroviral treatment in a pediatric cohort under care in two hospitals in Addis Ababa, Ethiopia. Poor adherence and pre-treatment advanced clinical stages were predictors of survival.

背景

埃塞俄比亚于 2005 年推出了免费抗逆转录病毒疗法。每年接受二线抗逆转录病毒治疗的患者人数都在增加。本研究的目的是描述在埃塞俄比亚亚的斯亚贝巴的耶卡蒂特 12 号和泽维图纪念医院这两家转诊医院接受二线抗逆转录病毒治疗的儿童和青少年的临床、免疫和病毒学结局。

方法

这是一项在年龄在 18 岁及以下并接受二线抗逆转录病毒药物治疗的儿童和青少年中进行的基于医院的回顾性队列研究。使用结构化问卷收集数据。名义变量使用平均值和百分比表示。使用统计软件 SPSS 23.0 进行统计分析。使用 Kaplan-Meier 分析、长期秩检验和多变量 Cox 比例模型来确定影响生存的因素。

结果

共研究了 75 名儿童和青少年，平均年龄为 13.28 岁（标准差：4 岁），二线方案治疗平均时间为 35.2 个月（标准差：21.8 个月）。48 名参与者在二线抗逆转录病毒治疗的所有三个参数上均取得成功。10 名患者出现病毒学治疗失败，7 名患者死亡。治疗失败和死亡率在治疗的头两年都较高。治疗依从性差（调整后的危险比：5.1（95%CI：1.1-23.2；p 值=0.02））和二线抗逆转录病毒治疗开始时的世界卫生组织临床分期较晚（调整后的危险比：7.51（95%CI：1.35-18.02；p 值=0.002））与接受治疗的儿童和青少年的生存显著相关。