肯尼亚基苏木感染艾滋病毒儿童中与艾滋病毒耐药性检测相关的临床、心理社会及结构因素：Opt4Kids研究数据的二次分析

Clinical, Psychosocial, and Structural Factors Associated with the Detection of HIV Drug Resistance in Children Living with HIV in Kisumu, Kenya: Secondary Analysis of Data from the Opt4Kids Study.

作者信息

Scallon Andrea J, Maheria Pooja, Oyaro Patrick, Thomas Katherine K, Chohan Bhavna H, Odhiambo Francesca, Brown Evelyn, Ochomo Edwin, Karauki Enericah, Yongo Nashon, Hassan Shukri A, Bishop Marley D, Beck Ingrid A, Boyce Ceejay, Frenkel Lisa M, Abuogi Lisa, Patel Rena C

机构信息

Elson S. Floyd College of Medicine, Washington State University, Spokane, WA 99202, USA.

Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35233, USA.

出版信息

Viruses. 2025 Sep 16;17(9):1246. doi: 10.3390/v17091246.

DOI:10.3390/v17091246

PMID:41012674

Abstract

BACKGROUND

HIV drug resistance (DR) mutations can compromise antiretroviral therapy (ART) success among children living with HIV (CLHIV). We conducted a secondary analysis using data from a randomized control trial for ART monitoring among CLHIV in Kisumu County, Kenya from 2019 to 2023, to assess clinical, psychosocial, and structural factors associated with HIV DR.

METHODS

704 CLHIV were followed for 12+ months, with characteristics captured at enrollment and follow-up visits in the "parent" randomized-controlled-trial (of point-of-care plasma viral load testing and for viremias ≥ 1000 copies/mL HIV genotyping for DR vs. standard-of-care) and an observational "extension" substudy (of participants on a dolutegravir-containing ART with genotyping performed on viremic specimens ≥ 200 copies/mL). A multivariate modified Poisson regression model was used to analyze factors associated with sequences yielding a Stanford HIVDR database DR penalty score (DR-PS) ≥ 30 to a nucleos(t)ides and/or non-nucleoside reverse transcriptase inhibitor, protease inhibitor (PI), and/or integrase inhibitor (INSTI).

RESULTS

Among 113 (16.1%) participants who underwent genotyping, 93 (82.3%) had a DR-PS ≥ 30. DR-PS ≥ 30 were associated with age 1-5 years (adjusted risk ratio (ARR) = 1.84; 95% confidence interval (CI): 1.07, 3.14), history of viremia ≥ 1000 copies/mL (ARR = 4.18; 95% CI: 2.77, 6.31), prescription of a PI- (ARR = 6.05; 95% CI: 3.43, 10.68) or INSTI-containing regimen (ARR = 1.83; 95% CI: 1.08, 3.11), poor adherence to ART (ARR = 1.91; 95% CI: 1.32, 2.76), lack of caregiver confidence in ART administration (ARR = 1.89; 95% CI: 1.11, 3.22), and mid-sized clinic populations (ARR = 0.55; 95% CI: 0.33, 0.92).

CONCLUSION

Addressing social factors associated with DR-PS ≥ 30 may improve ART success among CLHIV.

摘要

背景

HIV耐药（DR）突变可能会影响感染HIV儿童（CLHIV）抗逆转录病毒治疗（ART）的成功率。我们利用2019年至2023年在肯尼亚基苏木县开展的一项针对CLHIV进行ART监测的随机对照试验数据进行了二次分析，以评估与HIV DR相关的临床、心理社会和结构因素。

方法

对704名CLHIV进行了12个月以上的随访，在“母体”随机对照试验（即时护理血浆病毒载量检测以及病毒血症≥1000拷贝/mL时进行HIV基因分型以检测DR与标准护理）和一项观察性“扩展”子研究（对接受含多替拉韦的ART治疗且病毒血症标本≥200拷贝/mL时进行基因分型的参与者）的入组和随访时记录其特征。使用多变量修正泊松回归模型分析与在斯坦福HIVDR数据库中对核苷类和/或非核苷类逆转录酶抑制剂、蛋白酶抑制剂（PI）和/或整合酶抑制剂（INSTI）产生DR惩罚分数（DR-PS）≥30的序列相关的因素。

结果

在113名（16.1%）接受基因分型的参与者中，93名（82.3%）的DR-PS≥30。DR-PS≥30与1至5岁年龄（调整风险比（ARR）=1.84；95%置信区间（CI）：1.07，3.14）、病毒血症≥1000拷贝/mL的病史（ARR = 4.18；95% CI：2.77，6.31）、含PI方案（ARR = 6.05；95% CI：3.43，10.68）或含INSTI方案的处方（ARR = 1.83；95% CI：1.08，3.11）、对ART的依从性差（ARR = 1.91；95% CI：1.32，2.76）、护理人员对ART给药缺乏信心（ARR = 1.89；95% CI：1.11，3.22）以及中等规模的诊所人群（ARR = 0.55；95% CI：0.33，0.92）相关。