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. 2022 May 31;112(6):413-417.
In resource-limited settings, holding regimens such as lamivudine monotherapy (LAM) have been used to manage HIV-positive children failing combination antiretroviral therapy to mitigate the risk of drug resistance developing, while adherence barriers are addressed or when access to second- or third-line regimens is restricted. South African HIV treatment guidelines previously advocated the use of LAM to manage HIV-infected children with virological failure. However, the outcomes of patients on LAM compared with those who continued on a failing regimen have not been well described. Objectives. To investigate characteristics of a large cohort of children placed on LAM and their outcomes. Methods. This was a retrospective review of children with virological failure and the documented M184V drug resistance mutation who were placed on LAM v. a control group of children who continued on a failing regimen despite persistent virological failure. Virological and immunological outcomes of LAM were compared with those in patients who remained on a failing regimen. Results. A total of 179 children were included in the analysis, with 92 in the LAM group and 87 in the control group. The median (interquartile range (IQR)) age at baseline was 9.2 (5.4 - 12) years, the median CD4 count was 384 (184 - 622) cells/μL, and the median HIV viral load was 4.7 (IQR 3.7 - 5.3) log10. Twenty-two children (25.6%) in the LAM group and 15 (17.4%) in the control group experienced immunological deterioration. There was no statistical difference between the two groups with regard to overall time to immunological deterioration (log-rank p-value 0.4810). Conclusion. Given that a higher proportion of children in the LAM group experienced immunological failure, the LAM strategy may be a useful short-term one but should be restricted to children with limited treatment options. Managing children with virological failure will continue to be a challenge until improved adherence strategies are available.
在资源有限的情况下，人们一直采用拉米夫定单药治疗（LAM）等维持治疗方案来管理因联合抗逆转录病毒治疗失败而转为 HIV 阳性的儿童，以降低耐药性发展的风险，同时解决治疗依从性障碍或二线或三线治疗方案受限的问题。南非的 HIV 治疗指南此前曾提倡使用 LAM 来管理因病毒学失败而感染 HIV 的儿童。然而，接受 LAM 治疗的患者与继续接受失败治疗方案的患者的结局之间的差异尚未得到很好的描述。目的。调查接受 LAM 治疗的大量儿童患者的特征及其结局。方法。这是一项对因病毒学失败且有记录的 M184V 耐药突变而接受 LAM 治疗的儿童与尽管持续病毒学失败但继续接受失败治疗方案的对照组儿童进行的回顾性研究。比较了 LAM 组与继续接受失败治疗方案组的病毒学和免疫学结局。结果。共纳入 179 例儿童进行分析，其中 LAM 组 92 例，对照组 87 例。基线时的中位（四分位距（IQR））年龄为 9.2（5.4-12）岁，中位 CD4 计数为 384（184-622）细胞/μL，中位 HIV 病毒载量为 4.7（IQR 3.7-5.3）log10。LAM 组有 22 例（25.6%）儿童和对照组有 15 例（17.4%）儿童出现免疫恶化。两组在总体免疫恶化时间方面无统计学差异（对数秩检验 p 值 0.4810）。结论。鉴于 LAM 组中更多的儿童出现免疫失败，LAM 策略可能是一种有用的短期策略，但应仅限于治疗选择有限的儿童。在改进治疗依从性策略可用之前，管理因病毒学失败而转为 HIV 阳性的儿童仍将是一个挑战。
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