From the Research Department, Elizabeth Glaser Pediatric AIDS Foundation, Washington DC.
Research Department, Elizabeth Glaser Pediatric AIDS Foundation, Maputo, Mozambique.
Pediatr Infect Dis J. 2023 Oct 1;42(10):893-898. doi: 10.1097/INF.0000000000004037. Epub 2023 Jul 6.
Dolutegravir (DTG) was scaled up globally to optimize treatment for children living with HIV. We evaluated the rollout and virological outcomes after DTG introduction in Mozambique.
Data from children 0-14 years with visits from September 2019 to August 2021 were extracted from records in 16 facilities in 12 districts. Among children ever on DTG, we report treatment switches, defined as changes in anchor drug, regardless of changes to nucleoside reverse transcriptase inhibitor (NRTI) backbones. Among those on DTG for ≥6 months, we described viral load suppression rates by children newly initiating and switching to DTG and by the NRTI backbone at the time of the DTG switch.
Overall, 3,347 children were ever on DTG-based treatment (median age 9.5 years; 52.8% female). Most children (3,202, 95.7%) switched to DTG from another antiretroviral regimen. During the 2-year follow-up, 9.9% never switched from DTG; 52.7% had 1 regimen change, of which 97.6% were switched to DTG. However, 37.2% of children experienced ≥2 anchor drug changes. Overall median time on DTG was 18.6 months; nearly all children ≥5 years (98.6%) were on DTG at the last visit. Viral suppression was 79.7% (63/79) for children newly initiating DTG and 85.8% (1,775/2,068) for those switching to DTG. Suppression rates were 84.8% and 85.7% among children who switched and maintained NRTI backbones, respectively.
Viral suppression rates of ≥80% with minor variations by backbone were achieved during the 2-year DTG rollout. However, there were multiple anchor drug switches for over one-third of children, which may be attributable in part to drug stockouts. Long-term pediatric HIV management will only be successful with immediate and sustainable access to optimized child-friendly drugs and formulations.
多替拉韦（DTG）在全球范围内扩大使用，以优化艾滋病毒感染者儿童的治疗。我们评估了莫桑比克引入 DTG 后的推广情况和病毒学结果。
从 2019 年 9 月至 2021 年 8 月在 12 个地区的 16 个设施的记录中提取了 0-14 岁儿童的就诊数据。在曾接受 DTG 治疗的儿童中，我们报告了治疗转换，定义为改变主要药物，无论是否改变核苷逆转录酶抑制剂（NRTI）骨干。在接受 DTG 治疗≥6 个月的儿童中，我们描述了新开始和转换至 DTG 治疗的儿童以及 DTG 转换时 NRTI 骨干的病毒载量抑制率。
总体而言，3347 名儿童曾接受基于 DTG 的治疗（中位年龄 9.5 岁；52.8%为女性）。大多数儿童（3202 名，95.7%）从另一种抗逆转录病毒方案转换为 DTG。在 2 年的随访中，9.9%的儿童从未从 DTG 转换；52.7%的儿童有 1 种方案改变，其中 97.6%转换为 DTG。然而，37.2%的儿童经历了≥2 种主要药物的改变。总体上 DTG 的中位治疗时间为 18.6 个月；几乎所有≥5 岁的儿童（98.6%）在最后一次就诊时都在使用 DTG。新开始使用 DTG 的儿童病毒抑制率为 79.7%（63/79），转换至 DTG 的儿童为 85.8%（1775/2068）。转换并维持 NRTI 骨干的儿童的抑制率分别为 84.8%和 85.7%。
在 2 年的 DTG 推广过程中，实现了≥80%的病毒抑制率，且不同骨干的变化很小。然而，超过三分之一的儿童经历了多次主要药物的转换，这可能部分归因于药物短缺。只有立即获得并可持续获得优化的儿童友好型药物和配方，长期的儿科艾滋病毒管理才能取得成功。
