Anderson Kim, Rabie Helena, Eley Brian S, Frigati Lisa, Nuttall James, Kalk Emma, Heekes Alexa, Sridhar Gayathri, Ragone Leigh, Vannappagari Vani, Mudaly Vanessa, Boulle Andrew, Davies Mary-Ann
Centre for Integrated Data and Epidemiological Research, School of Public Health, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
Department of Paediatrics and Child Health, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa.
J Int AIDS Soc. 2025 Feb;28(2):e26418. doi: 10.1002/jia2.26418.
Globally, children living with HIV continue to lag behind UNAIDS targets for viral suppression (VS). Because studies with linked mother-child data are limited, we describe VS and associated factors among young children in a setting with early infant HIV testing (at birth, age 10 weeks and 6 months) and early protease inhibitor-based first-line antiretroviral therapy (ART).
We analysed routinely collected mother-child data for children living with HIV born 2018-2022 in Western Cape province, South Africa (followed through mid-2023). We assessed associations between child and maternal viral load (VL) results at 12 and 24 months after child ART start using logistic regression, adjusted for child sex, birthyear, severity of child immunodeficiency at ART start, maternal age and timing of maternal HIV diagnosis.
Among 2219 children living with HIV; 30% were diagnosed at birth (≤7 days), 41% before age 1 year (8-365 days) and 29% at age >1 year. Overall, 5% (n = 112/2219) of children died, a third of whom had not started ART; 90% of children (n = 1990) started ART, at median age 5 months (IQR 1-16). Median follow-up from ART start was 26 months (IQR 14-40). Among children with available VL at 12 months (n = 853/1582), 24 months (n = 614/1129) and 36 months (n = 350/658) after ART start, 36%, 43% and 48% were virally suppressed, respectively (VL<100 copies/ml). VS among children at 12 and 24 months was more likely if maternal VL was <100 versus ≥100 copies/ml at 12 months (adjusted odds ratio [aOR] = 3.5; 95% CI 1.9-6.5) and 24 months (aOR = 6.1; 95% CI 2.8-13.1) after child ART start. Children with no/mild versus advanced/severe immunodeficiency at ART start were more likely to achieve VS at 12 months (aOR = 2.3; 95% CI 1.3-4.2) but not at 24 months. Eligible children with missing VL at 24 months (39%) were more likely to have gaps in care of >6 months than those with VL≥100 or VL<100 copies/ml (84% vs. 28% vs. 14%, respectively; p<0.001).
Less than half of children on ART achieved VS, and children were more likely to achieve VS if their mothers were also virally suppressed. Significant efforts are needed to support mother-child dyads to achieve optimal VS.
在全球范围内，感染艾滋病毒的儿童在实现病毒抑制（VS）方面仍落后于联合国艾滋病规划署的目标。由于有关母婴关联数据的研究有限，我们描述了在一个开展早期婴儿艾滋病毒检测（出生时、10周龄和6月龄）以及基于蛋白酶抑制剂的早期一线抗逆转录病毒疗法（ART）的环境中幼儿的病毒抑制情况及相关因素。
我们分析了2018年至2022年在南非西开普省出生的感染艾滋病毒儿童的常规收集的母婴数据（随访至2023年年中）。我们使用逻辑回归评估了儿童开始接受抗逆转录病毒治疗后12个月和24个月时儿童和母亲病毒载量（VL）结果之间的关联，并对儿童性别、出生年份、开始接受抗逆转录病毒治疗时儿童免疫缺陷的严重程度、母亲年龄和母亲艾滋病毒诊断时间进行了调整。
在2219名感染艾滋病毒的儿童中；30%在出生时（≤7天）被诊断出，41%在1岁前（8 - 365天）被诊断出，29%在1岁后被诊断出。总体而言，5%（n = 112/2219）的儿童死亡，其中三分之一尚未开始接受抗逆转录病毒治疗；90%的儿童（n = 1990）开始接受抗逆转录病毒治疗，中位年龄为5个月（四分位间距1 - 16）。从开始接受抗逆转录病毒治疗起的中位随访时间为26个月（四分位间距14 - 40）。在开始接受抗逆转录病毒治疗后12个月（n = 853/1582）、24个月（n = 614/1129）和36个月（n = 350/658）有可用病毒载量数据的儿童中，病毒得到抑制（病毒载量<100拷贝/毫升）的儿童分别为36%、43%和48%。如果母亲在儿童开始接受抗逆转录病毒治疗后12个月时病毒载量<100拷贝/毫升而不是≥100拷贝/毫升，以及在24个月时，12个月和24个月时儿童实现病毒抑制的可能性更大（调整后的优势比[aOR] = 3.5；95%置信区间1.9 - 6.5）和（aOR = 6.1；95%置信区间2.8 - 13.1）。开始接受抗逆转录病毒治疗时无/轻度免疫缺陷与重度/极重度免疫缺陷的儿童在12个月时更有可能实现病毒抑制（aOR = 2.3；95%置信区间1.3 - 4.2），但在24个月时并非如此。24个月时病毒载量数据缺失的符合条件儿童（39%）比病毒载量≥100或病毒载量<100拷贝/毫升的儿童更有可能出现超过6个月的护理中断（分别为84%对28%对14%；p<0.001）。
接受抗逆转录病毒治疗的儿童中不到一半实现了病毒抑制，如果他们的母亲也实现了病毒抑制，儿童更有可能实现病毒抑制。需要做出重大努力来支持母婴二人组实现最佳的病毒抑制。
