Alexandre A C Mendes-Ferreira, Nazle Mendonça Collaço Véras, Rosana Elisa Gonçalves Gonçalves Pinho, Ana Roberta Pascom, Lúcio Gama, Vivian I Avelino-Silva
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We investigated factors associated with HIV DR, viral suppression, and survival up to 3 years old using multivariable models. Lastly, we describe the annual prevalence of each type of HIV DR in Brazilian children with HIV between 2009 and 2020.</p><p><strong>Results: </strong>We included 1152 children with HIV with a median age of 5 months at genotype testing; 57% were females. R<sub>1</sub> was observed in 30%, R<sub>2</sub> in 17%, and R<sub>3</sub> in 21%. Children with HIV whose birth parents were exposed to nevirapine or efavirenz before delivery had higher odds of R<sub>2</sub> (odds ratio 3.4; 95% confidence interval [CI] 1.1-10.8). Children with HIV with R<sub>1</sub> or R<sub>3</sub> had higher rates of death than those with HIV with no HIV DR in the adjusted models (adjusted hazard ratios 4.7 [95% CI 1.6-13.9] and 4.1 [95% CI 1.4-12.4], respectively). The prevalence of resistance to nevirapine and efavirenz peaked in 2015. Over time, the prevalence of genotyping tests with no detected resistance varied between 57% and 87%.</p><p><strong>Conclusion: </strong>HIV DR is highly prevalent in children with HIV and is associated with lower survival.</p>","PeriodicalId":13176,"journal":{"name":"HIV Medicine","volume":" ","pages":""},"PeriodicalIF":2.8000,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"HIV drug resistance, viral suppression, and survival in children living with HIV in Brazil.\",\"authors\":\"Alexandre A C Mendes-Ferreira, Nazle Mendonça Collaço Véras, Rosana Elisa Gonçalves Gonçalves Pinho, Ana Roberta Pascom, Lúcio Gama, Vivian I Avelino-Silva\",\"doi\":\"10.1111/hiv.13714\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction: </strong>Mutations associated with HIV drug resistance (DR) affect clinical outcomes. 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引用次数: 0
摘要
导言：与艾滋病耐药性（DR）相关的突变会影响临床结果。了解儿科人群中 HIV DR 的患病率及其与病毒抑制和存活率的关系，是为患者护理和卫生政策提供信息的关键：方法：我们利用巴西的监测系统确定了 2009 年至 2020 年间对年龄小于 18 个月的 HIV 感染儿童进行的基因分型检测。我们使用三个标准对艾滋病毒 DR 进行了分类：任何艾滋病毒 DR（R1）、对奈韦拉平或依非韦伦的 DR（R2）以及对巴西指南中推荐的至少一种抗逆转录病毒药物的 DR（R3）。我们使用多变量模型研究了与艾滋病 DR、病毒抑制和 3 岁以下存活率相关的因素。最后，我们描述了 2009 年至 2020 年间巴西儿童艾滋病病毒感染者中每种艾滋病 DR 的年流行率：我们共纳入了 1152 名感染艾滋病毒的儿童，他们接受基因型检测时的中位年龄为 5 个月；其中 57% 为女性。30% 的儿童检测出 R1，17% 的儿童检测出 R2，21% 的儿童检测出 R3。亲生父母在分娩前曾接触过奈韦拉平或依非韦伦的艾滋病患儿出现 R2 的几率更高（几率比 3.4；95% 置信区间 [CI] 1.1-10.8）。在调整后的模型中，R1 或 R3 的艾滋病病毒感染儿童的死亡率高于无 HIV DR 的艾滋病病毒感染儿童（调整后的危险比分别为 4.7 [95% CI 1.6-13.9] 和 4.1 [95% CI 1.4-12.4]）。奈韦拉平和依非韦伦的耐药性流行率在 2015 年达到高峰。随着时间的推移，未检测到耐药性的基因分型检测流行率介于 57% 和 87% 之间：艾滋病毒耐药性在感染艾滋病毒的儿童中非常普遍，并且与较低的存活率有关。
HIV drug resistance, viral suppression, and survival in children living with HIV in Brazil.
Introduction: Mutations associated with HIV drug resistance (DR) affect clinical outcomes. Understanding the prevalence of HIV DR and its association with viral suppression and survival in the paediatric population is key to inform patient care and health policies.
Methods: We used Brazilian monitoring systems to identify genotyping tests performed in children living with HIV aged ≤18 months between 2009 and 2020. We categorized HIV DR using three criteria: any HIV DR (R1), DR to nevirapine or efavirenz (R2), and DR to at least one antiretroviral recommended for children with HIV in Brazilian guidelines (R3). We investigated factors associated with HIV DR, viral suppression, and survival up to 3 years old using multivariable models. Lastly, we describe the annual prevalence of each type of HIV DR in Brazilian children with HIV between 2009 and 2020.
Results: We included 1152 children with HIV with a median age of 5 months at genotype testing; 57% were females. R1 was observed in 30%, R2 in 17%, and R3 in 21%. Children with HIV whose birth parents were exposed to nevirapine or efavirenz before delivery had higher odds of R2 (odds ratio 3.4; 95% confidence interval [CI] 1.1-10.8). Children with HIV with R1 or R3 had higher rates of death than those with HIV with no HIV DR in the adjusted models (adjusted hazard ratios 4.7 [95% CI 1.6-13.9] and 4.1 [95% CI 1.4-12.4], respectively). The prevalence of resistance to nevirapine and efavirenz peaked in 2015. Over time, the prevalence of genotyping tests with no detected resistance varied between 57% and 87%.
Conclusion: HIV DR is highly prevalent in children with HIV and is associated with lower survival.
期刊介绍：
HIV Medicine aims to provide an alternative outlet for publication of international research papers in the field of HIV Medicine, embracing clinical, pharmocological, epidemiological, ethical, preclinical and in vitro studies. In addition, the journal will commission reviews and other feature articles. It will focus on evidence-based medicine as the mainstay of successful management of HIV and AIDS. The journal is specifically aimed at researchers and clinicians with responsibility for treating HIV seropositive patients.
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