Department of Virology, Faculty of Health Sciences, Sefako Makgatho Health Sciences University, Pretoria, South Africa; Department of Virology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
S Afr Med J. 2021 Mar 2;111(3):255-259. doi: 10.7196/SAMJ.2021.v111i3.15221.
Large cohorts of HIV-1 perinatally infected children with long-term follow-up in developing countries are limited.
To explore rates and predictors of virological failure in a paediatric cohort.
A 10-year retrospective study was conducted from January 2004 to December 2013 to determine the incidence of and factors associated with virological failure among 1 659 HIV perinatally infected children in a public sector setting in South Africa (SA). Children aged <17 years who initiated first-line antiretroviral therapy between 1 January 2004 and 31 December 2013 and had at least 5 years of HIV viral load measurements were eligible.
The 1 659 children contributed 7 075 person-years of follow-up (PYFU). In the initial cohort of 2 024 children, 51.0% were male and 62.0% were aged <5 years. The incidence of virological failure was 18.7 per 100 PYFU. Virological failure was associated with male gender, death of the mother, concurrent tuberculosis treatment and World Health Organization stage IV disease. Of the 320 HIV isolates successfully amplified, 249 (77.8%) had drug resistance mutations.
We observed high rates of virological failure and emergence of HIV drug resistance mutations. Despite gains made by SA in the treatment of HIV, such results challenge the country's ability to meet global targets of 90% viral suppression by 2020.
在发展中国家，针对先天感染 HIV-1 的大量儿童患者进行长期随访的大型队列研究较为有限。
探究一个儿科队列中病毒学失败的发生率和预测因素。
本研究为 2004 年 1 月至 2013 年 12 月进行的一项 10 年回顾性研究，旨在确定南非公立医疗系统中 1659 例先天感染 HIV 的儿童中病毒学失败的发生率和相关因素。符合研究条件的患儿为 2004 年 1 月 1 日至 2013 年 12 月 31 日期间首次接受一线抗逆转录病毒治疗且 HIV 病毒载量检测时间至少达 5 年、年龄＜17 岁的患儿。
1659 例患儿共提供了 7075 人年随访（PYFU）。在最初的 2024 例患儿队列中，51.0%为男性，62.0%的患儿年龄＜5 岁。病毒学失败的发生率为 18.7/100 PYFU。病毒学失败与患儿的性别（男性）、母亲死亡、同时接受结核病治疗以及世界卫生组织（WHO）分期为 IV 期有关。在成功扩增的 320 个 HIV 分离株中，有 249 个（77.8%）发生了耐药突变。
我们观察到较高的病毒学失败率和 HIV 耐药突变的出现。尽管南非在 HIV 治疗方面取得了进展，但这些结果对该国实现 2020 年全球 90%病毒抑制目标的能力提出了挑战。
