半寿期预测在埃塞俄比亚西北部结核和艾滋病毒合并感染儿童中一线抗逆转录病毒治疗失败及其危险因素；多环境历史随访研究。

Half-life time prediction of developing first-line antiretroviral treatment failure and its risk factors among TB and HIV co-infected children in Northwest Ethiopia; multi setting historical follow-up study.

机构信息

Department of Paediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia.

Department of Epidemiology and Biostatistics, University of Gondar, Gondar, Ethiopia.

出版信息

BMC Pediatr. 2022 Mar 3;22(1):114. doi: 10.1186/s12887-022-03177-6.

DOI:10.1186/s12887-022-03177-6

PMID:35241036

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8892785/

Abstract

BACKGROUND

Even though treatment failure is higher among TB and HIV infected children in a resource-limited setting, there is no prior evidence in general and in the study area in particular. Hence, this study was aimed at determining the half-life time prediction of developing first-line antiretroviral treatment failure and its risk factors among TB and HIV co-infected children.

METHODS

A historical follow-up study was employed among 239 TB and HIV co-infected children from January 2010-December 2020. The data was entered into Epi data version 4.2.2 and exported to STATA 14.0 Software for analysis. The Kaplan-Meier plot was used to estimate the half-life time to develop treatment failure. The required assumption was fulfilled for each predictor variable. Additionally, those variables having a p-value ≤0.25 in the bivariable analysis were fitted into a multivariable Cox-proportional hazards regression model. P-value, < 0.05 was used to declare a significant association.

RESULTS

A total of 239 TB and HIV co-infected children were involved in this study. The overall half-life time to develop first treatment failure was found to be 101 months, with a total of 1027.8 years' follow-up period. The incidence rate and proportion of developing first-line treatment failure were 5.5 per 100 PPY (Person-Year) [CI (confidence interval): 3.7, 6.9] 100 PPY and 23.8% (CI; 18.8, 29.7) respectively. Factors such as hemoglobin 10 mg/dl [AHR (Adjusted Hazard Ratio): 3.2 (95% CI: 1.30, 7.73), severe acute malnutrition [AHR: 3.8 (95% CI: 1.51, 79.65), World Health Organization stage IV [AHR: 2.4 (95% CI: 1.15, 4.93)], and cotrimoxazole prophylaxis non user [AHR: 2.3 (95% CI: 1.14, 4.47)] were found to be a risk factor to develop treatment failure.

CONCLUSION

In this study, the half-life time to develop first-line treatment failure was found to be very low. In addition, the incidence was found to be very high. The presence of hemoglobin 10 mg/dl, severe acute malnutrition, World Health Organization stage, and non-use of cotrimoxazole prophylaxis were discovered to be risk factors for treatment failure. Further prospective cohort and qualitative studies should be conducted to improve the quality of care in paediatric ART clinics to reduce the incidence or burden of first line treatment failure among TB and HIV co-infected children.

摘要

背景

在资源有限的环境下，结核病（TB）和人类免疫缺陷病毒（HIV）感染儿童的治疗失败率更高，但尚无普遍证据，特别是在研究地区。因此，本研究旨在确定一线抗逆转录病毒治疗失败的半衰期预测及其在 TB 和 HIV 合并感染儿童中的危险因素。

方法

对 2010 年 1 月至 2020 年 12 月期间的 239 名 TB 和 HIV 合并感染儿童进行了一项历史随访研究。数据输入 EpiData 版本 4.2.2 并导出到 STATA 14.0 软件进行分析。Kaplan-Meier 图用于估计发展治疗失败的半衰期时间。对每个预测变量都满足了所需的假设。此外，在单变量分析中 p 值≤0.25 的变量被拟合到多变量 Cox 比例风险回归模型中。p 值<0.05 用于表示显著关联。

结果

本研究共纳入 239 名 TB 和 HIV 合并感染儿童。发现发展为首次治疗失败的总半衰期为 101 个月，总随访时间为 1027.8 年。发病率和首次一线治疗失败的比例分别为每 100 人每年（人年）5.5 例（置信区间：3.7，6.9）和 23.8%（置信区间：18.8，29.7）。血红蛋白<10mg/dl[调整后危险比（AHR）：3.2（95%置信区间：1.30，7.73）]、严重急性营养不良（AHR：3.8（95%置信区间：1.51，79.65）]、世界卫生组织（WHO）IV 期（AHR：2.4（95%置信区间：1.15，4.93）]和未使用复方磺胺甲噁唑预防（AHR：2.3（95%置信区间：1.14，4.47）]等因素被发现是发展治疗失败的危险因素。

结论

在本研究中，首次一线治疗失败的半衰期时间发现非常低。此外，发病率也非常高。血红蛋白<10mg/dl、严重急性营养不良、WHO 分期和未使用复方磺胺甲噁唑预防被发现是治疗失败的危险因素。应进一步开展前瞻性队列和定性研究，以提高儿科 ART 诊所的护理质量，降低 TB 和 HIV 合并感染儿童首次一线治疗失败的发生率或负担。