Birhanu Molla Yigzaw, Bekele Getamesay Molla, Endalew Bekalu, Alemu Simegn, Lashargie Cheru Tesema, Birhanu Dereje Ayalew, Mulualem Assefa, Jemberie Selamawit Shita
Department of Public Health, College of Health Sciences, Debre Markos University, P.O.Box 269, Debre Markos, Ethiopia.
Department of Gynecology and Obstetrics, School of Medicine, Debre Markos University, Debre Markos, Ethiopia.
BMC Pediatr. 2024 Dec 27;24(1):839. doi: 10.1186/s12887-024-05324-7.
The emergence of First-line Antiretroviral Therapy (ART) regimens fails; it necessitates the use of more costly and less tolerable second-line medications. Therefore, it is crucial to identify and address factors that increase the likelihood of first-line ART regimen failure in children. Although numerous primary studies have examined the incidence of first-line ART failure among HIV-infected children in Ethiopia, national-level data on the onset and predictors remain inconsistent. Hence, this study was conducted to fill the gaps in determining the onset of first-line ART failure and its predictors among HIV-infected children in Ethiopia.
Articles related to our topic of interest were searched using a systematic approach in national and international electronic databases. The retrospective follow-up cohort studies published in English up to 2022 were included. The data were extracted using a Microsoft Excel spread sheet and exported into Stata™ Version 17.0 for further management and analysis. The level of heterogeneity was quantified using I test together with a 95% confidence interval (CI). The incidence of the primary estimates was estimated using a random effects model in the Dersimonian-Lairedmethod. Subgroup analysis, Meta regression, and sensitivity analysis were computed to identify the source of heterogeneity but not explained. The predictors of first-line ART failure were explained using relative risk (RR) with 95% confidence interval (CI).
Ten studies having a total of 5446 children were included. The pooled onset of first-line ART failure was 3.18 (95% CI: 1.91, 4.44) per 100 child-years of observations. Those study participants who began ART at an advanced WHO clinical stage at ART initiation had a 3.05 (95% CI: 1.47, 6.36), having poor ART adherence had a 2.19 (95% CI: 1.29, 3.70), and having TB-HIV coinfection at ART initiation had a 1.43 (95% CI: 1.06, 1.94) times higher chance of experiencing first-line ART failure than their corresponding counterparts.
The onset of first-line ART failure was high to achieve the 2030 UNAIDS target of ending the AIDS epidemic. Advanced WHO clinical stage, poor first-line ART adherence, and having TB-HIV coinfection were identified predictors. Hence, community HIV screening should continue to strengthen early ART initiation, and the attention of ART adherence should be kept to achieve ending the AIDS epidemic. The baseline tests and diagnosis, like TB diagnosis should be maintained for HIV-infected children while they begin ART.
一线抗逆转录病毒疗法（ART）方案出现失败情况；这就需要使用成本更高且耐受性更低的二线药物。因此，识别并解决增加儿童一线ART方案失败可能性的因素至关重要。尽管众多初步研究已考察了埃塞俄比亚HIV感染儿童中一线ART失败的发生率，但关于发病情况及预测因素的国家级数据仍不一致。因此，开展本研究以填补埃塞俄比亚HIV感染儿童中确定一线ART失败发病情况及其预测因素方面的空白。
采用系统方法在国内和国际电子数据库中检索与我们感兴趣主题相关的文章。纳入截至2022年以英文发表的回顾性随访队列研究。使用Microsoft Excel电子表格提取数据，并导出到Stata™ 17.0版本中进行进一步管理和分析。使用I检验及95%置信区间（CI）对异质性水平进行量化。主要估计值的发生率采用DerSimonian-Laired方法中的随机效应模型进行估计。进行亚组分析、Meta回归和敏感性分析以识别未解释的异质性来源。使用相对风险（RR）及95%置信区间（CI）解释一线ART失败的预测因素。
纳入了10项研究，共有5446名儿童。每100儿童年观察期内一线ART失败的合并发病情况为3.18（95% CI：1.91，4.44）。那些在ART启动时处于世界卫生组织临床晚期开始接受ART的研究参与者发生一线ART失败的可能性是相应对照者的3.05倍（95% CI：1.47，6.36），ART依从性差的为2.19倍（95% CI：1.29，3.70），在ART启动时合并结核-HIV感染的为1.43倍（95% CI：1.06，1.94）。
一线ART失败的发病情况较高，难以实现2030年联合国艾滋病规划署终结艾滋病流行的目标。已确定世界卫生组织临床晚期、一线ART依从性差以及合并结核-HIV感染为预测因素。因此，社区HIV筛查应继续加强ART的早期启动，并应持续关注ART依从性以实现终结艾滋病流行。对于HIV感染儿童在开始ART时应维持基线检测和诊断，如结核诊断。
