Uganda Protestant Medical Bureau, P.O. Box 4127, Kampala, Uganda.
Infectious Diseases Institute, Makerere University College of Health Sciences, P.O. Box 22418, Kampala, Uganda.
BMC Infect Dis. 2024 Sep 27;24(1):1057. doi: 10.1186/s12879-024-09930-9.
In Uganda, 20% (19,073/94,579) of children and adolescents (0-19 years) living with HIV (CALHIV) were receiving second-line antiretroviral therapy (ART) by the end of March 2020. Data on incidence and predictors of virological failure among these CALHIV on second-line ART is limited. Lack of this information and limited access to HIV drug resistance testing prevents early identification of CALHIV at risk of virological failure on second-line ART. The aim of this study was to determine the incidence and predictors of virological failure among CALHIV on second-line ART in Uganda.
This was a retrospective cohort study of all CALHIV aged 0-19 years who were switched to second-line ART regimen between June 2010 and June 2019 at the Baylor Uganda Centre of Excellence clinic. Data was analysed using STATA 14. Cumulative incidence curves were used to assess incidence of virological failure. Factors associated with virological failure were identified using sub-distributional hazard regression analysis for competing risks considering death, transfer out and loss to follow-up as competing risks.
Of 1104 CALHIV, 53% were male. At switch to Protease Inhibitor (PI) based second-line ART, majority (47.7%) were aged 5 - 9 years,56.2% had no/mild immune suppression for age while 77% had viral load copies < 100,000 copies/mL. The incidence of virological failure on second-line ART regimen among CALHIV was 3.9 per 100 person-years (PY) with a 10-year cumulative incidence rate of 32%. Factors significantly associated with virological failure were age 10 - 19 years (HR 3.2, 95% 1.6 - 6.2, p < 0.01) and HIV viral load count > 100,000 copies/mL (HR 2.2, 95% CI 1.5 - 3.1), p < 0.01) prior to second-line ART switch.
Treatment outcomes for children and adolescents on second-line ART are favourable with one third of them developing virological failure at 10 years of follow up. Adolescent age group and high HIV viral load at the start of second-line ART were significantly associated with virological failure on second-line ART. There is need to determine optimal strategies to improve ART treatment outcomes among adolescents with high viral load counts at second-line ART switch.
在乌干达，截至 2020 年 3 月底，20%（19073/94579）的儿童和青少年（0-19 岁）艾滋病毒感染者（CALHIV）正在接受二线抗逆转录病毒治疗（ART）。关于这些接受二线 ART 治疗的 CALHIV 中病毒学失败的发生率和预测因素的数据有限。缺乏这些信息以及有限的获得艾滋病毒耐药性检测的机会，使得无法早期识别有发生二线 ART 病毒学失败风险的 CALHIV。本研究的目的是确定乌干达接受二线 ART 治疗的 CALHIV 中病毒学失败的发生率和预测因素。
这是一项回顾性队列研究，纳入了 2010 年 6 月至 2019 年 6 月期间在贝勒乌干达卓越中心诊所转用二线 ART 方案的所有 0-19 岁的 CALHIV。数据使用 STATA 14 进行分析。使用竞争风险的亚分布风险回归分析，考虑死亡、转出和失访作为竞争风险，评估病毒学失败的累积发生率曲线。
在 1104 名 CALHIV 中，53%为男性。在转为基于蛋白酶抑制剂（PI）的二线 ART 时，大多数（47.7%）年龄为 5-9 岁，56.2%的免疫抑制程度为无/轻度，而 77%的病毒载量<100,000 拷贝/ml。CALHIV 二线 ART 方案的病毒学失败发生率为每 100 人年 3.9 例（PY），10 年累积发生率为 32%。与病毒学失败显著相关的因素是 10-19 岁年龄组（HR 3.2，95%CI 1.6-6.2，p<0.01）和二线 ART 转换前 HIV 病毒载量>100,000 拷贝/ml（HR 2.2，95%CI 1.5-3.1，p<0.01）。
接受二线 ART 治疗的儿童和青少年的治疗结果良好，其中三分之一在 10 年的随访中发生病毒学失败。青少年年龄组和二线 ART 开始时的高 HIV 病毒载量与二线 ART 病毒学失败显著相关。需要确定最佳策略，以改善二线 ART 转换时病毒载量高的青少年的 ART 治疗结果。
