Abebe Estifanos Belay, Gebregeorgis Meseret Ekubay, Seid Fuad Ahmed, Zemariam Alemu Birara, Dejene Tadesse Mamo, Masresha Seteamlak Adane
Department of Pediatrics Health, Woldia Comprehensive Specialized Hospital, Woldia, Ethiopia.
Department of Public Health, Debre Berhan University, Debre Berhan, Ethiopia.
Front Pediatr. 2024 Mar 7;12:1249957. doi: 10.3389/fped.2024.1249957. eCollection 2024.
Despite anti-retroviral treatment coverage in resource-limited countries being highly appreciated, the occurrence of first-line virological failure remains a priority agenda. Therefore, this study serves as an input for evidence of virological failure among children.
This study aimed to assess the incidence and predictors of virological failure among children receiving first-line anti-retroviral treatment in public comprehensive specialized hospitals found in Northeast Ethiopia through a retrospective follow-up study.
A multicenter institution-based retrospective follow-up study was conducted on the medical records of 481 human immunodeficiency virus (HIV)-infected children who were on first-line anti-retroviral therapy from 1 January 2017 to 31 December 2021. Data were retrieved from 15 May to 15 June 2022 at three public comprehensive specialized hospitals. Study participants were recruited using a simple random sampling technique. STATA-14 was used to analyze the data, which was entered using EpiData version 4.6.2.0. The Kaplan-Meier estimator was used to estimate the survival. Both bivariable and multivariable Cox regression models were fitted to identify predictors. Finally, adjusted hazards ratios (AHRs) with 95% confidence intervals (CIs) were computed, and variables with a -value of <0.05 were considered statistically significant predictors of virological failure.
A total of 481 children records were included in the final analysis, with an observed follow-up period of 16,379 person-months. Among these, 60 (12.47%) had developed virological failure, resulting in an overall incidence density rate of 3.67 (95% CI; 2.84, 4.73) per 1000 person-month observations. The hazards of virological failure (VF) among children were found to be increased by being in recent WHO stages III and IV (AHR = 3.688; 95% CI: 1.449-6.388), poor adherence to anti-retroviral treatment (ART) (AHR = 3.506; 95% CI: 1.711-7.234), and living in a rural environment (AHR = 5.013; 95% CI: 1.958-8.351). Conversely, the hazard of VF was reduced by 60% when the age of caregivers was less than 40 years (AHR = 0.405; 0.003-0.449).
The incidence rate of virological failure was relatively high. Living in a rural area, poor adherence to ART, being in a recent advanced WHO clinical stage, and having a caregiver of 40 years of age or older were all independent predictors of virological failure in children. Patients or parents (caregivers) need to be aware of the importance of strictly adhering to treatment regimens to prevent virological failure.
尽管资源有限国家的抗逆转录病毒治疗覆盖率广受赞誉，但一线病毒学失败的发生仍是一个优先议程。因此，本研究为儿童病毒学失败的证据提供了参考。
本研究旨在通过回顾性随访研究，评估埃塞俄比亚东北部公立综合专科医院中接受一线抗逆转录病毒治疗的儿童病毒学失败的发生率及预测因素。
对2017年1月1日至2021年12月31日期间接受一线抗逆转录病毒治疗的481例人类免疫缺陷病毒（HIV）感染儿童的病历进行了一项基于多中心机构的回顾性随访研究。2022年5月15日至6月15日从三家公立综合专科医院检索数据。采用简单随机抽样技术招募研究参与者。使用STATA - 14分析数据，数据通过EpiData 4.6.2.0版本录入。采用Kaplan - Meier估计量来估计生存率。拟合双变量和多变量Cox回归模型以确定预测因素。最后，计算95%置信区间（CI）的调整风险比（AHR），P值<0.05的变量被视为病毒学失败的统计学显著预测因素。
最终分析共纳入481例儿童记录，观察随访期为16379人月。其中，60例（12.47%）发生病毒学失败，总体发病密度率为每1000人月观察期3.67（95%CI：2.84，4.73）。发现儿童病毒学失败（VF）的风险因处于世界卫生组织（WHO）近期III期和IV期而增加（AHR = 3.688；95%CI：1.449 - 6.388），抗逆转录病毒治疗（ART）依从性差（AHR = 3.506；95%CI：1.711 - 7.234），以及生活在农村环境（AHR = 5.013；95%CI：1.958 - 8.351）。相反，当照顾者年龄小于40岁时，VF风险降低60%（AHR = 0.405；0.003 - 0.449）。
病毒学失败的发生率相对较高。生活在农村地区、抗逆转录病毒治疗依从性差、处于世界卫生组织近期晚期临床阶段以及照顾者年龄在40岁及以上均是儿童病毒学失败的独立预测因素。患者或父母（照顾者）需要意识到严格遵守治疗方案对预防病毒学失败的重要性。
