Bearden David R, Sportiello Kristen, Mweemba Milimo, Lungu Frank, Mwanza-Kabaghe Sylvia, Birbeck Gretchen
Neurology Research Office, University Teaching Hospital, Lusaka, Zambia.
Department of Neurology, University of Rochester Medical Center, Rochester, New York, United States of America.
medRxiv. 2024 Sep 18:2024.09.17.24313837. doi: 10.1101/2024.09.17.24313837.
Based on recent World Health Organization recommendations, there has been a large-scale transition in Sub-Saharan Africa to integrase inhibitor (II)-based antiretroviral therapy (ART) regimens.
This study was conducted at an urban referral center in Lusaka, Zambia.
This study included 297 children and adolescents with HIV (CAWH) on ART for one year prior to enrollment and followed for 1-4 years after enrollment. ART adherence, ART regimen, and viral load were assessed periodically. Structured interviews were conducted with a subset of 95 children to assess adherence barriers and side effects.
Children on protease inhibitor (PI)-based regimens were more likely to report adherence problems than children taking II- or Efavirenz-based regimens (10% vs. 28%, p=0.03) and noted more days with missed doses (median 1 vs. 0, p=0.02). In interviews, the most common reasons given for poor adherence included bad medication taste, not being home when medications were due, and perceived side effects. The PI group was more likely to report that taste was a problem affecting adherence (22% vs. 4%, p=0.05) and headache as an ART side effect (17% vs. 4%, p=0.05). Switching from a PI- to an II-based regimen was associated with improved adherence (72% vs. 92%, p=0.01) and an undetectable viral load (67% vs. 78%).
Switching CAWH from PI-based to II-based regimens has many advantages including superior side effect profiles, adherence, and viral suppression. PI taste aversion may be a significant contributor to pediatric adherence issues. Palatability should be considered in pediatric HIV drug development.
根据世界卫生组织最近的建议，撒哈拉以南非洲地区已大规模转向以整合酶抑制剂（II）为基础的抗逆转录病毒疗法（ART）方案。
本研究在赞比亚卢萨卡的一家城市转诊中心进行。
本研究纳入了297名感染艾滋病毒的儿童和青少年（CAWH），他们在入组前已接受ART治疗一年，并在入组后随访1至4年。定期评估ART依从性、ART方案和病毒载量。对95名儿童进行了结构化访谈，以评估依从性障碍和副作用。
与接受以II或依非韦伦为基础方案的儿童相比，接受以蛋白酶抑制剂（PI）为基础方案的儿童更有可能报告依从性问题（10%对28%，p = 0.03），并且漏服剂量的天数更多（中位数为1天对0天，p = 0.02）。在访谈中，依从性差的最常见原因包括药物味道不好、服药时不在家以及感觉有副作用。PI组更有可能报告味道是影响依从性的问题（22%对4%，p = 0.05），以及头痛是ART的副作用（17%对4%，p = 0.05）。从基于PI的方案转换为基于II的方案与依从性改善（72%对92%，p = 0.01）和病毒载量不可检测（67%对78%）相关。
将感染艾滋病毒的儿童和青少年从基于PI的方案转换为基于II的方案有许多优点，包括更好的副作用特征、依从性和病毒抑制。PI味道厌恶可能是儿童依从性问题的一个重要因素。在儿科艾滋病毒药物开发中应考虑适口性。
