Hawassa University College of Medicine and Health Sciences, School of Medical Laboratory Science, Ethiopia.
J Immunol Res. 2021 Apr 9;2021:2498025. doi: 10.1155/2021/2498025. eCollection 2021.
To determine immunological and virological failure and associated factors among children infected with human immunodeficiency virus receiving antiretroviral treatments at Hawassa University Hospital, Southern Ethiopia.
A hospital-based cross-sectional study was conducted among 273 HIV-infected children from July 1 to December 1, 2019. Data were collected using a structured questionnaire and review of patient records. Blood samples for viral load and CD4 count were collected. Data were analyzed using SPSS version 20. Significance group comparison was done by the Kaplan-Meier log-rank test. The Cox proportional hazard model was used to select significant factors of the variability between groups.
A total of 273 children, between the age ranges of 1 to 14 years, were included. Of these, 139 (50.9%) and 134 (49.1%) were males and females, respectively. Children from the rural area were almost five times more vulnerable for virological and immunological failure than those children from the urban area (AOR = 4.912, (1.276-8.815), = 0.032). The overall viral load suppression was 196 (71.8%) with a good adherence of 226 (82.9%). Nonsuppressed HIV viral load was found to be 77 (28.2%) which had two times more viral load copies (AOR = 2.01, (1.21-2.66), = 0.001) when compared to those who had suppressed viral load copies. The proportions of children who had immunological nonresponse were 45.6% (21 out of 46), 30.4% (14 out of 46), and 23.9% (11 out of 46) among children with baseline CD4 of <200, 201-500, and >500 cells/l, respectively. Unimproved outcomes among females were noted for immunological and virological failure in this study (AOR = 1.901, (1.038-3.481), = 0.038).
In conclusion, the highly active antiretroviral treatment appeared highly effective in terms of immunological and virological long-term outcomes. However, viral suppression (71.8%) in our study was far apart from the UNAIDS target of 90% in 2020. For that reason, strengthening adherence counseling and early initiation of HAART is important.
在埃塞俄比亚南部 Hawassa 大学医院接受抗逆转录病毒治疗的感染人类免疫缺陷病毒的儿童中，确定免疫和病毒学失败以及相关因素。
2019 年 7 月 1 日至 12 月 1 日，对 273 名感染 HIV 的儿童进行了一项基于医院的横断面研究。使用结构化问卷和病历回顾收集数据。采集血样进行病毒载量和 CD4 计数检测。使用 SPSS 20 版进行数据分析。采用 Kaplan-Meier 对数秩检验进行显著性组比较。Cox 比例风险模型用于选择组间变异的显著因素。
共纳入 273 名年龄在 1 至 14 岁之间的儿童。其中，男性 139 名（50.9%），女性 134 名（49.1%）。来自农村地区的儿童发生病毒学和免疫学失败的风险几乎是来自城市地区儿童的五倍（AOR=4.912，（1.276-8.815），=0.032）。总体上，有 196 名（71.8%）儿童的病毒载量得到抑制，226 名（82.9%）儿童的药物依从性良好。未抑制的 HIV 病毒载量为 77 名（28.2%），与病毒载量得到抑制的儿童相比，未抑制的 HIV 病毒载量的病毒载量拷贝数高出两倍（AOR=2.01，（1.21-2.66），=0.001）。在基线 CD4<200、201-500 和>500 个细胞/l 的儿童中，分别有 45.6%（21 名中有 14 名）、30.4%（14 名中有 14 名）和 23.9%（11 名中有 11 名）出现免疫无应答。本研究中，女性在免疫和病毒学失败方面的治疗结果无改善（AOR=1.901，（1.038-3.481），=0.038）。
总之，高效抗逆转录病毒治疗在免疫和病毒学长期结果方面似乎非常有效。然而，在我们的研究中，病毒抑制率（71.8%）远低于 2020 年联合国艾滋病规划署（UNAIDS）设定的 90%的目标。因此，加强药物依从性咨询和及早开始高效抗逆转录病毒治疗非常重要。
