Elizabeth Glaser Pediatric AIDS Foundation, Maseru, Lesotho.
Elizabeth Glaser Pediatric AIDS Foundation, Washington, D.C., United States of America.
PLoS One. 2023 Jul 17;18(7):e0288619. doi: 10.1371/journal.pone.0288619. eCollection 2023.
We describe transition of HIV-positive children from efavirenz- or nevirapine-based antiretroviral therapy (ART) to optimal dolutegravir (DTG) or lopinavir/ritonavir (LPV/r) (solid formulation)-based ART in Lesotho.
We followed a cohort of children less than 15 years of age who were initiated on ART on or after January 1, 2018 from 21 selected health facilities in Lesotho. From March 2020 to May 2022, we collected data retrospectively through chart abstraction and prospectively through caregiver interviews to cover a period of 24 months following treatment initiation. We used a structured questionnaire to collect data on demographics, ART regimen, drug formulations and switches, viral suppression, retention, and drug administration challenges. Data were summarized as frequencies and percentages, using SAS ver.9.4.
Of 310 children enrolled in the study, 169 (54.5%) were female, and median age at ART initiation was 5.9 years (IQR 1.1-11.1). During follow-up, 19 (6.1%) children died, 41 (13.2%) were lost to follow-up and 74 (23.9%) transferred to non-study sites. At baseline, 144 (46.4%) children were receiving efavirenz-based ART regimen, 133 (42.9%) LPV/r, 27 (8.7%) DTG, 5 (1.6%) nevirapine; 1 child had incomplete records. By study end, 143 (46.1%) children were receiving LPV/r-based ART regimen, 109 (35.2%) DTG, and 58 (18.7%) were on efavirenz or nevirapine-based regimen. Of 116 children with viral load results after six months or more on a consistent regimen, viral suppression was seen in 35/53 (66.0%) children on LPV/r, 36/38 (94.7%) children on DTG and 19/24 (79.2%) children on efavirenz.
Following optimal ART introduction in Lesotho, most children in the cohort were transitioned and many attained or maintained viral suppression after transition; however, we recommend more robust viral load monitoring and patient tracking to reduce losses and improve outcomes after ART transition.
我们描述了莱索托将接受依非韦伦或奈韦拉平为基础的抗逆转录病毒治疗（ART）的 HIV 阳性儿童转换为更优的多替拉韦（DTG）或洛匹那韦/利托那韦（LPV/r）（固体制剂）为基础的 ART。
我们对 2018 年 1 月 1 日或之后在莱索托 21 家选定的卫生机构开始接受 ART 的年龄小于 15 岁的儿童进行了队列研究。从 2020 年 3 月到 2022 年 5 月，我们通过病历回顾和护理人员前瞻性访谈收集了数据，涵盖了治疗开始后 24 个月的时间。我们使用结构化问卷收集了人口统计学、ART 方案、药物配方和转换、病毒抑制、保留和药物管理挑战的数据。使用 SAS ver.9.4 对数据进行了汇总，以频率和百分比表示。
在 310 名入组研究的儿童中，有 169 名（54.5%）为女性，ART 开始时的中位年龄为 5.9 岁（IQR 1.1-11.1）。在随访期间，有 19 名（6.1%）儿童死亡，41 名（13.2%）失访，74 名（23.9%）转至非研究地点。基线时，有 144 名（46.4%）儿童接受依非韦伦为基础的 ART 方案，133 名（42.9%）接受 LPV/r，27 名（8.7%）接受 DTG，5 名（1.6%）接受奈韦拉平；1 名儿童记录不完整。研究结束时，有 143 名（46.1%）儿童接受 LPV/r 为基础的 ART 方案，109 名（35.2%）接受 DTG，58 名（18.7%）接受依非韦伦或奈韦拉平为基础的方案。在 116 名接受至少六个月持续治疗方案后有病毒载量结果的儿童中，53 名（66.0%）接受 LPV/r、38 名（94.7%）接受 DTG 和 24 名（79.2%）接受依非韦伦的儿童病毒抑制。
在莱索托推出更优的 ART 后，队列中的大多数儿童都进行了转换，许多儿童在转换后实现或维持了病毒抑制；然而，我们建议更加强化病毒载量监测和患者跟踪，以减少 ART 转换后的失访并改善结局。
