Chantal BIYA International Reference Centre for research on HIV/AIDS prevention and management (CIRCB), Yaoundé, Cameroon.
Faculty of Medicine and Biomedical Sciences (FMSB), University of Yaoundé I, Yaoundé, Cameroon.
HIV Med. 2021 Aug;22(7):567-580. doi: 10.1111/hiv.13095. Epub 2021 Mar 31.
Adolescents living with perinatal HIV infection (ALPHI) experience persistently high mortality rates, particularly in resource-limited settings. It is therefore clinically important for us to understand the therapeutic response, acquired HIV drug resistance (HIVDR) and associated factors among ALPHI, according to geographical location.
A study was conducted among consenting ALPHI in two urban and two rural health facilities in the Centre Region of Cameroon. World Health Organization (WHO) clinical staging, self-reported adherence, HIVDR early warning indicators (EWIs), immunological status (CD4 count) and plasma viral load (VL) were assessed. For those experiencing virological failure (VF, VL ≥ 1000 copies/mL), HIVDR testing was performed and interpreted using the Stanford HIV Drug Resistance Database v.8.9-1.
Of the 270 participants, most were on nonnucleoside reverse transcriptase inhibitor (NNRTI)-based regimens (61.7% urban vs. 82.2% rural), and about one-third were poorly adherent (30.1% vs. 35.1%). Clinical failure rates (WHO-stage III/IV) in both settings were < 15%. In urban settings, the immunological failure (IF) rate (CD < 250 cells/μL) was 15.8%, statistically associated with late adolescence, female gender and poor adherence. The VF rate was 34.2%, statistically associated with poor adherence and NNRTI-based antiretroviral therapy. In the rural context, the IF rate was 26.9% and the VF rate was 52.7%, both statistically associated with advanced clinical stages. HIVDR rate was over 90% in both settings. EWIs were delayed drug pick-up, drug stock-outs and suboptimal viral suppression.
Poor adherence, late adolescent age, female gender and advanced clinical staging worsen IF. The VF rate is high and consistent with the presence of HIVDR in both settings, driven by poor adherence, NNRTI-based regimen and advanced clinical staging.
围产期感染艾滋病毒的青少年（ALPHI）死亡率持续居高不下，尤其是在资源有限的环境中。因此，了解地理位置不同的 ALPHI 的治疗反应、获得性艾滋病毒耐药性（HIVDR）和相关因素在临床上非常重要。
在喀麦隆中心地区的两个城市和两个农村卫生机构中，对同意参与的 ALPHI 进行了一项研究。评估了世界卫生组织（WHO）临床分期、自我报告的依从性、HIVDR 早期预警指标（EWI）、免疫状态（CD4 计数）和血浆病毒载量（VL）。对于那些出现病毒学失败（VF，VL≥1000 拷贝/ml）的患者，进行了 HIVDR 检测，并使用斯坦福 HIV 耐药性数据库 v.8.9-1 进行了解释。
在 270 名参与者中，大多数人正在接受非核苷类逆转录酶抑制剂（NNRTI）为基础的治疗方案（城市 61.7%，农村 82.2%），约三分之一的人依从性差（城市 30.1%，农村 35.1%）。在两个环境中，临床失败率（WHO 分期 III/IV）均低于 15%。在城市环境中，免疫失败（IF）率（CD<250 个细胞/μL）为 15.8%，与青春期晚期、女性和依从性差统计学相关。VF 率为 34.2%，与依从性差和基于 NNRTI 的抗逆转录病毒治疗统计学相关。在农村环境中，IF 率为 26.9%，VF 率为 52.7%，均与晚期临床分期统计学相关。在两个环境中，HIVDR 率均超过 90%。EWI 包括药物延迟获取、药物缺货和病毒抑制不理想。
依从性差、青春期晚期、女性和晚期临床分期会加重 IF。VF 率很高，与两个环境中 HIVDR 的存在一致，这是由依从性差、基于 NNRTI 的方案和晚期临床分期驱动的。
