在喀麦隆进行的一项队列分析中发现，在接受基于多替拉韦的治疗方案与其他治疗方案的病毒未得到抑制的儿童和青少年中，强化依从性咨询后出现病毒学治疗失败的情况：相关证据。
Confirmed virological failure following enhanced adherence counseling among virally unsuppressed children and adolescents on dolutegravir-based versus other regimens: Evidence from a cohort analysis in Cameroon.
作者信息
Bouba Yagai, Ka'e Aude Christelle, Anguechia Gouissi Davy-Hyacinthe, Ayafor Cynthia, Tameza Guebiapsi Dominik, Sosso Samuel Martin, Simo Kamgaing Rachel, Ndiang Tetang Suzie, Essamba Suzane, Kamgaing Nelly, Ndejo Atsinkou Sabine, Ketchaji Alice, Nka Alex Durand, Nguendjoung Fainguem Nadine, Tommo Tchouaket Michel Carlos, Takou Desiré, Jagni Semengue Ngoufack Ezechiel, Amougou Atsama Marie, Nwobegahay Julius, Eyoum Bille Bertrand, Gatchuessi Kenmegne Sandra, Ateba Ndongo Francis, Noukayo Felicité, Awoh Ajeh Rogers, Cherif Hamsatou Hadja, Ndie Justin, Wepnyu Njamnshi Yembe, Naah Felicité, Zoung-Kanyi Bissek Anne-Cecile, Billong Serge Clotaire, Koki Ndombo Paul, Adawaye Chatte, Cappelli Giulia, Ekane Halle Gregory-Edie, Armenia Daniele, Santoro Maria Mercedes, Ceccherini-Silberstein Francesca, Ndembi Nicaise, Ndjolo Alexis, Colizzi Vittorio, Perno Carlo-Federico, Fokam Joseph
机构信息
Departmental Faculty of Medicine and Surgery, Saint Camillus International University of Health Sciences, Rome, Italy.
Virology Laboratory, Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management, Yaoundé, Cameroon.
出版信息
Medicine (Baltimore). 2025 May 16;104(20):e42555. doi: 10.1097/MD.0000000000042555.
Achieving and maintaining viral suppression (VS) in pediatric populations remain suboptimal in low- and middle-income countries (LMICs), calling for the optimized management approaches. We compared the rate of confirmed virological failure (cVF) and associated factors among virally non-suppressed (VnS) children and adolescents after enhanced adherence counseling (EAC) on dolutegravir-based versus other regimens. A multicentre and prospective cohort study was conducted among ART-experienced children (<10 years) and adolescents (10-19 years) with VnS followed-up for confirmatory viral load (VL) after EAC. cVF was defined as 2 consecutive VL ≥ 1000 copies/mL after ≥6 months of ART and EAC. Overall, 250 individuals with VnS were enrolled, median [IQR] age was 12 (11-13) and median duration on ART was 57 (48-67) months. According to ART-regimens, 48.4% received DTG-based regimens (TDF/3TC/DTG: 32.8%; ABC/3TC + DTG: 15.6%). Overall, cVF rate was 39.2% (95% CI: 33.3-45.3), with a longer duration on ART among cVF-group (68 [60-79] months) versus VS-group (48 [45-61]), P = .026. According to ART-regimen, cVF rate was 29.3% in those receiving TDF/3TC/DTG versus 43.5% for ABC/3TC + ATV/r/LPV/r and 25.6% for ABC/3TC + DTG, P = .007. Regarding anchor-drugs, cVF with DTG, EFV and ATV/r/LPV/r was 28.1%, 48.4% and 49.2%, respectively, P = .007. Interestingly, 13.2% of participants with VS had detectable low-level viremia (400-999 copies/mL), with 5.8%, 7.7% and 12.9% being observed in those receiving DTG, ATV/r/LPV/r, and EFV/NVP-based regimen, respectively, P = .013. Only anchor-drug was found to be a predictor of cVF. Compared to those receiving DTG-based regimens, ART based on ATV/LPV/r (aOR [95% CI]: 0.298 [0.132-0.72], P = .004) or EFV/NVP (aOR [95% CI]: 0.401 [0.163-0.983], P = .046) was significantly less likely to achieve VS. About 40% of Cameroonian children/adolescents with VnS experience cVF, which is indicative that EAC significantly contributes to viral re-suppression (60%), especially with DTG-based regimens. Thus, implementing a strategy that couples DTG-transition with EAC-interventions would contribute substantially to efforts in eliminating pediatric AIDS in LMICs.
在低收入和中等收入国家（LMICs），实现并维持儿科人群的病毒抑制（VS）情况仍不理想，因此需要优化管理方法。我们比较了基于多替拉韦（DTG）方案与其他方案在加强依从性咨询（EAC）后病毒未被抑制（VnS）的儿童和青少年中确诊病毒学失败（cVF）的发生率及相关因素。对有抗逆转录病毒治疗（ART）经验的VnS儿童（<10岁）和青少年（10 - 19岁）进行了一项多中心前瞻性队列研究，在EAC后对其进行随访以确认病毒载量（VL）。cVF定义为在接受ART和EAC≥6个月后连续2次VL≥1000拷贝/mL。总体而言，共纳入250例VnS个体，年龄中位数[四分位间距]为12（11 - 13）岁，ART治疗时间中位数为57（48 - 67）个月。根据ART方案，48.4%的患者接受基于DTG的方案（替诺福韦酯/拉米夫定/多替拉韦：32.8%；阿巴卡韦/拉米夫定 + 多替拉韦：15.6%）。总体而言，cVF发生率为39.2%（95%置信区间：33.3 - 45.3），cVF组的ART治疗时间（68 [60 - 79]个月）长于VS组（48 [45 - 61]个月），P = 0.026。根据ART方案，接受替诺福韦酯/拉米夫定/多替拉韦方案的患者cVF发生率为29.3%，而接受阿巴卡韦/拉米夫定 + 阿扎那韦/利托那韦或洛匹那韦/利托那韦方案的为43.5%，接受阿巴卡韦/拉米夫定 + 多替拉韦方案的为25.6%，P = 0.007。关于核心药物，使用DTG、依非韦伦和阿扎那韦/利托那韦或洛匹那韦/利托那韦的cVF分别为28.1%、48.4%和49.2%，P = 0.007。有趣的是，13.2%的VS参与者有可检测到的低水平病毒血症（400 - 999拷贝/mL），接受DTG、阿扎那韦/利托那韦或洛匹那韦/利托那韦、依非韦伦/奈韦拉平方案的患者中分别有5.8%、7.7%和12.9%出现这种情况，P = 0.013。仅发现核心药物是cVF的一个预测因素。与接受基于DTG方案的患者相比，基于阿扎那韦/洛匹那韦/利托那韦的ART方案（调整后比值比[aOR][95%置信区间]：0.298 [0.132 - 0.72]，P = 0.004）或依非韦伦/奈韦拉平方案（aOR [95%置信区间]：0.401 [0.163 - 0.983]，P = 0.046）实现VS的可能性显著降低。约40%的喀麦隆VnS儿童/青少年经历了cVF，这表明EAC对病毒再次抑制有显著作用（60%），尤其是基于DTG的方案。因此，实施将DTG转换与EAC干预相结合的策略将极大地有助于在LMICs消除儿童艾滋病的努力。
Zotero 插件