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.

IF 3.5 3区医学 Q2 VIROLOGY

Viruses-Basel Pub Date : 2025-09-16 DOI:10.3390/v17091246

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

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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.

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临床、社会心理和结构因素与肯尼亚基苏木艾滋病毒感染儿童艾滋病毒耐药性检测相关：opt4儿童研究数据的二次分析

背景：艾滋病毒耐药（DR）突变可能影响艾滋病毒（CLHIV）儿童抗逆转录病毒治疗（ART）的成功。我们利用2019年至2023年肯尼亚基苏木县CLHIV抗逆转录病毒监测随机对照试验的数据进行了二次分析，以评估与HIV dr相关的临床、社会心理和结构因素。对704名CLHIV患者进行了12个月以上的随访，在“母体”随机对照试验（护理点血浆病毒载量检测和病毒血症≥1000拷贝/mL）和观察性“扩展”亚研究（使用含盐酸抗逆转录病毒药物的参与者，对病毒血症标本≥200拷贝/mL进行基因分型）的入组和随访中捕获了特征。使用多变量修正泊松回归模型分析与斯坦福HIVDR数据库DR惩罚评分(DR- ps)≥30的序列对核苷(t)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）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1-5岁相关(校正风险比(ARR) = 1.84；95%可信区间（CI）： 1.07, 3.14)，病毒血症史≥1000拷贝/mL (ARR = 4.18, 95% CI: 2.77, 6.31)，处方PI- (ARR = 6.05, 95% CI: 3.43, 10.68)或含有insi的方案（ARR = 1.83, 95% CI: 1.08, 3.11），抗逆转录病毒治疗依从性差（ARR = 1.91, 95% CI: 1.32, 2.76），护理人员对抗逆转录病毒治疗缺乏信心（ARR = 1.89, 95% CI: 1.11, 3.22），中等临床人群（ARR = 0.55, 95% CI: 0.33, 0.92）。结论：解决与DR-PS≥30相关的社会因素可能提高抗逆转录病毒治疗的成功率。

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来源期刊

Viruses-Basel VIROLOGY-

CiteScore

7.30

自引率

12.80%

发文量

2445

审稿时长

1 months

期刊介绍： Viruses (ISSN 1999-4915) is an open access journal which provides an advanced forum for studies of viruses. It publishes reviews, regular research papers, communications, conference reports and short notes. Our aim is to encourage scientists to publish their experimental and theoretical results in as much detail as possible. There is no restriction on the length of the papers. The full experimental details must be provided so that the results can be reproduced. We also encourage the publication of timely reviews and commentaries on topics of interest to the virology community and feature highlights from the virology literature in the ''News and Views'' section. Electronic files or software regarding the full details of the calculation and experimental procedure, if unable to be published in a normal way, can be deposited as supplementary material.