Department of Epidemiology, University of Washington, Seattle, WA.
Department of Global Health, University of Washington, Seattle, WA.
J Acquir Immune Defic Syndr. 2024 Aug 1;96(4):311-317. doi: 10.1097/QAI.0000000000003439.
Identifying determinants of longitudinal HIV viral load (VL) trajectories using group-based trajectory modeling (GBTM) can inform clinical strategies and mechanisms of nonadherence among children.
Children under 12 months old who were newly diagnosed with HIV were enrolled in the Optimizing Pediatric HIV therapy cohort (NCT00428116) from 2007 to 2010. Children initiated antiretroviral therapy at enrollment, and VL was assessed every 3 months for 24 months post-antiretroviral therapy and every 6 months thereafter up to 8 years old. VL trajectory groups were defined using GBTM. Fisher's exact and Kruskal-Wallis tests were used to determine the correlates of each trajectory group compared with the sustained-low VL group.
Five VL trajectory groups were identified among 89 children with 522 VL visits from 6 to 24 months: sustained-low (63% of children), sustained-very-high (16%), sustained-high (9%), low-to-high (7%), and high-with-periods-of-low (6%). Children in the sustained-high group were more frequently on a first-line protease inhibitor (PI)-based regimen (63% vs 38%; P = 0.03) and had younger caregivers (median: 22 vs 28 years; P = 0.02). Among 54 children with 560 VL visits followed from 48 to 96 months, 5 trajectory groups were identified: sustained-low (74%), mid-range (4%), periods-of-low (7%), high-to-low (7%), and sustained-high (7%). Those in the high-to-low group had younger caregivers (21 vs 29 years; P = 0.01).
GBTM identified unique VL patterns among children with unsuppressed VL. Caregiver and regimen-related characteristics were associated with patterns of nonsuppression. Younger caregivers may benefit from tailored counseling to help them support child antiretroviral therapy adherence. Palatable regimens are necessary for viral suppression among children with HIV.
使用基于群组的轨迹建模（GBTM）识别纵向 HIV 病毒载量（VL）轨迹的决定因素，可以为儿童提供临床策略和非依从性的机制。
2007 年至 2010 年，从新诊断为 HIV 的 12 个月以下儿童中招募了优化儿科 HIV 治疗队列（NCT00428116）的儿童。儿童在入组时开始接受抗逆转录病毒治疗，在抗逆转录病毒治疗后 24 个月内每 3 个月评估一次 VL，并在此后每 6 个月评估一次，直至 8 岁。使用 GBTM 定义 VL 轨迹组。Fisher 确切检验和 Kruskal-Wallis 检验用于确定每个轨迹组与持续低 VL 组相比的相关性。
在 89 名儿童的 522 次 VL 就诊中，从 6 至 24 个月期间，共确定了 5 个 VL 轨迹组：持续低（63%的儿童）、持续高（16%）、持续高（9%）、低至高（7%）和高低相间（6%）。处于持续高组的儿童更常接受一线蛋白酶抑制剂（PI）为基础的方案（63%比 38%；P=0.03），并且他们的照顾者更年轻（中位数：22 岁比 28 岁；P=0.02）。在 54 名儿童的 560 次 VL 就诊中，从 48 至 96 个月期间，共确定了 5 个轨迹组：持续低（74%）、中值（4%）、多次低（7%）、高低相间（7%）和持续高（7%）。处于高低相间组的儿童的照顾者更年轻（21 岁比 29 岁；P=0.01）。
GBTM 在未抑制 VL 的儿童中识别出独特的 VL 模式。照顾者和方案相关特征与非抑制模式相关。年轻的照顾者可能受益于量身定制的咨询，以帮助他们支持儿童抗逆转录病毒治疗的依从性。美味的方案对于 HIV 儿童的病毒抑制是必要的。
