Elizabeth Glaser Pediatrics AIDS Foundation, Mbabane, Eswatini.
Elizabeth Glaser Pediatrics AIDS Foundation, Washington, DC.
J Acquir Immune Defic Syndr. 2024 Nov 1;97(3):305-312. doi: 10.1097/QAI.0000000000003498. Epub 2024 Oct 7.
We assessed clinical outcomes among children, adolescents, and people younger than 25 years on darunavir-based antiretroviral therapy (ART) in 9 sub-Saharan African countries.
Third-line ART centers in Cameroon, Eswatini, Kenya, Lesotho, Nigeria, Rwanda, Uganda, Zambia, and Zimbabwe.
From January 2019 to December 2022, we collected data from a cohort of children, adolescents, and young people receiving third-line ART from 9 sub-Saharan African countries. Data on treatment continuity, viral suppression, death, and clinic transfers were extracted from medical records and summarized. Cox proportional hazards models were used to identify factors independently associated with retention in care.
Of 871 participants enrolled, the median age was 14.8 (range: 0.2-24.7) years and 488 (56.0%) were male; 809 (92.9%) [median duration of follow-up of 28.3 months (interquartile range: 17.5-45.2)] had final outcomes after initiating third-line ART. Of these, 711 (87.9%) were alive and in care at the end of study follow-up, 29 (3.6%) died, 30 (3.7%) were transferred to other facilities, and 39 (4.8%) were lost to follow-up. Retention in care was less likely among male patients compared with female patients [aHR: 0.85, 95% confidence interval: 0.72 to 1.0] and in 10-14-year-old children compared with younger children. Adolescents (15-19 years old) had higher mortality compared with children younger than 10 years (aSHR: 4.20, 95% confidence interval: 1.37 to 12.87). Viral suppression was seen in 345/433 (79.7%), 249/320 (77.8%), and 546/674 (81.0%) patients with results at 6 months, 12 months, and study end, respectively.
A high proportion of children and young people receiving third-line ART in sub-Saharan Africa remain in care and attain viral suppression during follow-up.
我们评估了在撒哈拉以南非洲 9 个国家接受基于达芦那韦的抗逆转录病毒治疗（ART）的儿童、青少年和 25 岁以下人群的临床结局。
喀麦隆、埃斯瓦蒂尼、肯尼亚、莱索托、尼日利亚、卢旺达、乌干达、赞比亚和津巴布韦的三线 ART 中心。
从 2019 年 1 月至 2022 年 12 月，我们从撒哈拉以南非洲 9 个国家接受三线 ART 的儿童、青少年和年轻人队列中收集数据。从病历中提取治疗连续性、病毒抑制、死亡和门诊转移的数据，并进行总结。使用 Cox 比例风险模型确定与保留护理相关的独立因素。
在 871 名入组的参与者中，中位年龄为 14.8 岁（范围：0.2-24.7 岁），488 名（56.0%）为男性；809 名（92.9%）[中位随访时间为 28.3 个月（四分位间距：17.5-45.2）]在开始三线 ART 后有最终结局。其中，711 名（87.9%）在研究随访结束时仍存活并在接受治疗，29 名（3.6%）死亡，30 名（3.7%）转至其他机构，39 名（4.8%）失访。与女性患者相比，男性患者[风险比：0.85，95%置信区间：0.72 至 1.0]和 10-14 岁儿童[风险比：0.67，95%置信区间：0.54 至 0.84]保留护理的可能性较小。青少年（15-19 岁）的死亡率高于 10 岁以下儿童[a 风险比：4.20，95%置信区间：1.37 至 12.87]。分别在 6 个月、12 个月和研究结束时，有 345/433（79.7%）、249/320（77.8%）和 546/674（81.0%）名患者的病毒抑制率达到了这一水平。
在撒哈拉以南非洲接受三线 ART 的儿童和青少年中，很大一部分人在随访期间仍在接受护理并达到病毒抑制。
