Essos Hospital Centre, National Social Insurance Fund Hospital, Yaoundé, Cameroon.
Higher Institute of Medical Technology, University of Douala, Yaoundé, Cameroon.
Trop Med Int Health. 2021 Aug;26(8):927-935. doi: 10.1111/tmi.13595. Epub 2021 May 13.
With scale-up of antiretroviral therapy (ART) children, treatment failure and switch to subsequent ART regimens are common. Our objectives were to evaluate switching practices and identify factors associated among children and adolescents failing their first-line ART.
A facility-based survey study was conducted in a cohort of children living with HIV experiencing virological failure (VF) at the Essos Hospital Centre of Yaounde, Cameroon. Data were collected using a standard questionnaire, and key variables were as follows: (a) VF defined as viral load (VL) > 1000 copies/ml, (b) rate of switch to second-line and (c) reason(s) for switching ART. Odds ratio (OR) with 95% confidence interval (CI) was used to assess the association between study variables, and P < 0.05 was considered statistically significant.
A total of 106 children experiencing VF were enrolled: median age was 8 [interquartile range (IQR): 3-15] years; 60.38% were boys and 39.62% were orphans of one/both parents. A proportion of 69% were at the WHO clinical stage III/IV, and 13.21% were experiencing immunological failure (CD4 < 200 cells/mm ). The median duration on first-line ART was 36 [IQR: 7-157] months prior to detecting VF, and the rate of switch to second-line ART was 70.75% (75/106). Delay in switching ART after a confirmed VF was 11 [IQR: 7-16] months. After switch to second-line ART, the median time to achieve undetectable VL (<40 copies/ml) was 14 [IQR: 9-21] months. Multivariate analysis revealed that only children with viral rebound (aOR = 0.09; 95% CI = 0.03-0.24) were less likely to be switched. Of note, being orphaned (aOR = 0.35, CI = 0.11-1.11), biological sex (aOR = 1.77, CI = 0.60-5.29) and immune status (aOR = 0.19, CI = 0.03-1.31, 0.09) had no significant effect on switching to second-line ART.
In this paediatric population experiencing VF after about 3-4 years from ART initiation, the majority are switched to second-line ART after a delay of almost one year. Delayed switch to second-line was driven essentially by viral rebound, underscoring the need for close viral monitoring.
随着抗逆转录病毒疗法（ART）的广泛应用，儿童患者中治疗失败和转换至后续 ART 方案的情况较为常见。本研究旨在评估儿童患者一线治疗失败后的转换治疗方案，并确定与转换治疗相关的因素。
在喀麦隆雅温得埃索斯医院中心，我们对一组正在接受 HIV 治疗的儿童进行了一项基于机构的调查研究，这些儿童出现了病毒学失败（VF）。我们使用标准问卷收集数据，关键变量包括：（a）VF 定义为病毒载量（VL）＞1000 拷贝/ml；（b）转换至二线方案的比例；（c）转换 ART 的原因。采用比值比（OR）及其 95%置信区间（CI）来评估研究变量之间的关联，P＜0.05 被认为具有统计学意义。
共纳入了 106 名出现 VF 的儿童：中位年龄为 8 岁（四分位距 [IQR]：3-15 岁）；60.38%为男孩，39.62%为父母一方或双方的孤儿。69%的儿童处于世界卫生组织（WHO）临床分期 III/IV 期，13.21%出现免疫功能失败（CD4＜200 个细胞/mm ）。在检测到 VF 之前，儿童接受一线 ART 的中位时间为 36 个月（IQR：7-157 个月），转换至二线 ART 的比例为 70.75%（75/106）。在确认 VF 后，ART 转换的延迟时间为 11 个月（IQR：7-16 个月）。转换至二线 ART 后，实现 VL 不可检测（＜40 拷贝/ml）的中位时间为 14 个月（IQR：9-21 个月）。多变量分析显示，仅出现病毒反弹的儿童更不可能进行转换治疗（调整比值比 [aOR] 0.09；95%CI 0.03-0.24）。值得注意的是，孤儿身份（aOR 0.35，95%CI 0.11-1.11）、生物学性别（aOR 1.77，95%CI 0.60-5.29）和免疫状态（aOR 0.19，95%CI 0.03-1.31，0.09）对转换至二线 ART 无显著影响。
在本研究中，在接受 ART 治疗 3-4 年后出现 VF 的儿科患者中，大多数在延迟近一年后转换至二线 ART 方案。延迟转换主要由病毒反弹驱动，这凸显了密切监测病毒载量的必要性。
