Marete Irene, Mwangi Ann, Brown Steven, Wools-Kaloustian Kara, Yiannoutsos Constantin, Abuogi Lisa, Lyamuya Rita, Ngonyani Kapella, Achieng Marion, Apaka Cosmas, Rotich Elyne, Ayaya Samuel
Department of Pediatrics and Child Health, Moi University School of Medicine, P.O. Box 4606-30100 Kenya.
Department of Behavioral Sciences, Moi University School of Medicine, P.O. Box 4606-30100 Kenya.
East Afr Med J. 2021;98(9):4082-4092.
To describe the incidence of antiretroviral treatment failure and associated factors in a pediatric clinical cohort within the East African International epidemiology Databases to Evaluate AIDS (EA-IeDEA) consortium.
A retrospective cohort study. Clinical treatment failure was defined as advancement in clinical WHO stage, or CDC class at least 24 weeks after initiation of treatment. Immunological failure was defined as developing or returning to the following age-related immunological thresholds after at least 24 weeks on treatment; CD4 count of <200 or CD4%<10% for children aged 2-5 years and CD4 count of < 100 for a child aged > 5years.
The study utilized the electronic medical records of HIV-infected pediatric patients enrolled into the EA-IeDEA consortium clinics from January 2005 to August 2012.
A total of 5927 children were included in the analysis. The estimated cumulative incidence of clinical ART treatment failure at one year and four years post ART initiation was11.5% and 31% respectively, while that of immunological treatment failure was at 3% and 22.5% respectively. The main factors associated with clinical failure were advanced clinical stage at ART-initiation, year started ART and residing in a rural area. Factors associated with immunological failure were male gender and age of the child at ART-initiation. Only 6% of those identified as having clinical treatment failure were switched to second line treatment during the four years of follow-up.
The probability of clinical and immunologic failure was relatively high and increased with time.
描述东非国际艾滋病流行病学数据库评估联盟（EA-IeDEA）中一个儿科临床队列中抗逆转录病毒治疗失败的发生率及相关因素。
一项回顾性队列研究。临床治疗失败定义为治疗开始至少24周后世界卫生组织（WHO）临床分期进展或美国疾病控制与预防中心（CDC）分级进展。免疫失败定义为治疗至少24周后出现或恢复到以下与年龄相关的免疫阈值；2至5岁儿童CD4细胞计数<200或CD4%<10%，5岁以上儿童CD4细胞计数<100。
该研究利用了2005年1月至2012年8月在EA-IeDEA联盟诊所登记的HIV感染儿科患者的电子病历。
共有5927名儿童纳入分析。抗逆转录病毒治疗（ART）开始后1年和4年临床ART治疗失败的估计累积发生率分别为11.5%和31%，而免疫治疗失败的累积发生率分别为3%和22.5%。与临床失败相关的主要因素是ART开始时临床分期较晚、开始ART的年份以及居住在农村地区。与免疫失败相关的因素是男性性别和ART开始时儿童的年龄。在四年的随访期间，被确定为临床治疗失败的患者中只有6%改用二线治疗。
临床和免疫失败的概率相对较高，且随时间增加。
