Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK.
MRC International Statistics and Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.
BMC Pediatr. 2022 Jun 11;22(1):340. doi: 10.1186/s12887-022-03400-4.
We investigated risk factors for sustained virological non-suppression (viral load ≥ 1000 copies/ml on two tests 48 weeks apart) among children and adolescents accessing HIV care in public sector clinics in Harare, Zimbabwe and Blantyre, Malawi.
Participants were enrolled between 2016 and 2019, were aged 6-19 years, living with HIV, had chronic lung disease (FEV z-score < -1) and had taken antiretroviral therapy (ART) for at least six months. We used multivariate logistic regression to identify risk factors for virological non-suppression after 48 weeks, among participants who were non-suppressed at enrolment.
At enrolment 258 participants (64.6%) were on first-line ART and 152/347 (43.8%) had virological non-suppression. After 48 weeks 114/313 (36.4%) were non-suppressed. Participants non-suppressed at baseline had almost ten times higher odds of non-suppression at follow-up (OR = 9.9, 95%CI 5.3-18.4, p < 0.001). Of those who were non-suppressed at enrolment, 87/136 (64.0%) were still non-suppressed at 48 weeks. Among this group non-suppression at 48 weeks was associated with not switching ART regimen (adjusted OR = 5.55; 95%CI 1.41-21.83); p = 0.014) and with older age. Twelve participants switched regimen in Zimbabwe and none in Malawi.
Viral non-suppression was high among this group and many with high viral load were not switched to a new regimen, resulting in continued non-suppression after 48 weeks. Further research could determine whether improved adherence counselling and training clinicians on regimen switches can improve viral suppression rates in this population.
Secondary cohort analysis of data from BREATHE trial (Clinicaltrials.gov NCT02426112 ).
我们研究了津巴布韦哈拉雷和马拉维布兰太尔公立诊所接受艾滋病毒护理的儿童和青少年中，持续病毒学抑制失败（两次相隔 48 周的检测中病毒载量≥1000 拷贝/ml）的危险因素。
参与者于 2016 年至 2019 年期间入组，年龄为 6-19 岁，HIV 感染者，患有慢性肺病（FEV z 评分<-1），已接受抗逆转录病毒治疗（ART）至少 6 个月。我们使用多变量逻辑回归来确定在入组时未被抑制的参与者在 48 周后病毒学抑制失败的危险因素。
在入组时，258 名参与者（64.6%）接受一线 ART，152/347 名（43.8%）病毒学未被抑制。48 周后，114/313 名（36.4%）未被抑制。基线时未被抑制的参与者在随访时未被抑制的可能性几乎高出十倍（OR=9.9，95%CI 5.3-18.4，p<0.001）。在入组时未被抑制的参与者中，87/136 名（64.0%）在 48 周时仍未被抑制。在该组中，48 周时未被抑制与未更换 ART 方案（调整后的 OR=5.55；95%CI 1.41-21.83；p=0.014）和年龄较大有关。在津巴布韦，有 12 名参与者更换了方案，而马拉维没有。
该组人群病毒学抑制率较高，许多高病毒载量的患者未更换新方案，导致 48 周后持续未被抑制。进一步的研究可以确定改善依从性咨询和培训临床医生更换方案是否可以提高该人群的病毒抑制率。
BREATHE 试验（Clinicaltrials.gov NCT02426112）数据的二次队列分析。
