Walubo Andrew, Baleni Refuoe, Mukudu Hillary, Kambafwile Henry, Dheda Mukesh, Thengwa Thanduxolo, Jiane Tshepang
Department of Pharmacology, University of the Free State, Bloemfontein, 9301, South Africa.
National Pharmacovigilance Center, National Department of Health, Pretoria, South Africa.
Int J MCH AIDS. 2021;10(1):146-155. doi: 10.21106/ijma.471. Epub 2021 Jul 10.
Over the past 15 years, there have been three major updates to the South African national guidelines for the management of human immunodeficiency virus (HIV) in children. The purpose of this study is to describe the clinical characteristics of children who were initiated on antiretroviral therapy (ART) in Bloemfontein, South Africa, following these national treatment guidelines.
Clinical information during initiation of ART in children aged 0-13 years was obtained from five HIV clinics in Bloemfontein from 2004 to 2019 as part of the establishment of an antiretroviral (ARV) pediatric registry at the University of the Free State. Data were analyzed for patient demographics, clinical presentation (World Health Organization (WHO) HIV-staging, growth rate and comorbid conditions), types of investigations done, and medicines prescribed.
The number of children initiated on ART increased from 168 in the period 2004-2009 to 349 (107.8%) in 2010-2014, and then dropped to 162 in the period 2015-2019. The increase in 2010-2014 was mainly in the <2 years age group by 54.8%, and in the 5 to 10 years age group by 344.4%. In the same period, the number of children with severe illness (WHO HIV-stage 4) decreased by 20.7%, while those with mild to moderate illness (WHO HIV-stage 2 and 3) increased by 17.3%. HIV infection was more severe in children under two years as more patients in this age group presented with WHO HIV-stages 3 and 4, severe underweight (below 3 percentile), severely suppressed CD4 count (< 25%), and a high viral load (> 1000 copies/ml). There was increased use of ABC/3TC/LPVr in the < 3-year age group and ABC/3TC/EFV in the > 3-year age group. There was reduced use of the stavudine and other regimens.
More children were started on ART and safer ARV drugs. Children under 2 years were the most debilitated by HIV, and there was an increase in HIV prevalence among children > 5 years. New strategies for the prevention and management of HIV among children in these two age groups are needed.
在过去15年中，南非儿童人类免疫缺陷病毒（HIV）管理的国家指南有三次重大更新。本研究的目的是描述在南非布隆方丹按照这些国家治疗指南开始接受抗逆转录病毒治疗（ART）的儿童的临床特征。
作为自由州大学抗逆转录病毒（ARV）儿科登记处建立工作的一部分，从2004年至2019年，从布隆方丹的五家HIV诊所获取了0至13岁儿童开始接受ART期间的临床信息。对患者人口统计学、临床表现（世界卫生组织（WHO）HIV分期、生长速率和合并症）、所做检查类型以及所开药物进行了数据分析。
开始接受ART的儿童数量从2004 - 2009年期间的168例增加到2010 - 2014年的349例（增长107.8%），然后在2015 - 2019年期间降至162例。2010 - 2014年的增长主要在<2岁年龄组，增长了54.8%，在5至10岁年龄组增长了344.4%。同期，重症患儿（WHO HIV 4期）数量减少了20.7%，而轻症至中症患儿（WHO HIV 2期和3期）数量增加了17.3%。2岁以下儿童的HIV感染更为严重，因为该年龄组更多患者呈现WHO HIV 3期和4期、严重体重不足（低于第3百分位）、CD4计数严重抑制（<25%）以及高病毒载量（>1000拷贝/ml）。<3岁年龄组中ABC/3TC/LPVr的使用增加，>3岁年龄组中ABC/3TC/EFV的使用增加。司他夫定和其他治疗方案的使用减少。
更多儿童开始接受ART且使用了更安全的ARV药物。2岁以下儿童受HIV影响最严重，5岁以上儿童中的HIV患病率有所上升。需要针对这两个年龄组儿童的HIV预防和管理的新策略。
