印度尼西亚艾滋病毒感染儿童一线抗逆转录病毒治疗的病毒学失败及其相关因素

IF 0.2 Q4 PEDIATRICS
N. Kurniati, Z. Munasir, Pramita Gayatri, E. Yunihastuti, B. Bela, A. Alam
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引用次数: 0

摘要

背景:世界卫生组织(WHO)建议对接受抗逆转录病毒治疗(ART)的HIV患者进行病毒载量(VL)监测。然而,在低收入国家,VL监测的可用性仍然有限。目的探讨未进行常规VL监测的hiv感染儿童病毒学失败的相关因素。方法本队列研究对2004年至2021年在Cipto Mangunkusumo总医院登记的艾滋病毒(CLHIV)儿童进行研究。没有常规进行病毒载量监测。接受ART治疗6个月后至少有一次VL结果的受试者被纳入研究。病毒学失败的定义是VL为1000个拷贝。受试者的数据来自医疗记录、实验室报告和配药药房。采用风险比进行生存分析后进行统计学分析。结果接受ART治疗后VL≥1次的患儿384例。诊断时的中位年龄为30个月。随访时间6 ~ 216个月,平均VL监测次数为0.7次/人/年。大多数受试者已处于临床3期和4期(77.8%);75%符合严重免疫缺陷标准。在接受一线抗逆转录病毒治疗中位数为33个月后,45.8%的受试者出现病毒学失败,发生率为每1000人月3.3例。独立相关因素为诊断年龄<60个月(HR 1.714;95%CI 1.13 - 2.6),严重免疫缺陷(HR 1.71;95%CI 1.15 - 2.54),转诊病例(HR 1.70;95%CI 1.23 - 2.36), WHO临床分期3 (HR 1.987;95%CI 0.995 ~ 3.969)和4 (HR 2.084;95%CI 1.034 ~ 4.201)。病毒学失败的受试者年龄体重z分数较低[中位数1.92;四分位数间距(IQR) -3.003至-0.81]和身高年龄z分数[中位数-2.05;IQR -2.902至-1.04]在故障时。在未接受常规VL监测的hiv感染儿童中,诊断年龄<60个月、严重免疫缺陷、WHO临床3期和4期以及从其他中心转诊的儿童与病毒学失败相关。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Virological failure of first-line antiretroviral therapy in children living with HIV in Indonesia and associated factors
Background The World Health Organization (WHO) recommends viral load (VL) monitoring for HIV patients on antiretroviral therapy (ART). However, availability of VL monitoring in low-income countries remains limited. Objective To investigate factors associated with virological failure in HIV-infected children treated without routine VL monitoring. Methods This cohort study was done in children living with HIV (CLHIV) registered at Cipto Mangunkusumo General Hospital from 2004 to 2021. Viral load monitoring was not routinely done. Subjects with at least one VL result after 6 months on ART were included in the study. Virological failure was defined as a VL of >1,000 copies. Subjects’ data were obtained from medical records, laboratory reports, and dispensing pharmacies. Statistical analysis was done following survival analysis with hazard ratio. Results There were 384 children who had at least 1 VL result after ART was initiated. Median age at diagnosis was 30 months. Length of follow-up ranged from 6 to 216 months, with a mean frequency of VL monitoring of 0.7 times/person/year. Most subjects were already in clinical stages 3 and 4 (77.8%); 75% met severe immunodeficiency criteria. Virological failure was found in 45.8% of subjects after a median of 33 months on first-line ART, yielding an incidence of 3.3 per 1,000 person months. Independent associated factors were age at diagnosis of <60 months (HR 1.714; 95%CI 1.13 to 2.6), severe immunodeficiency (HR 1.71; 95%CI 1.15 to 2.54), referral cases (HR 1.70; 95%CI 1.23 to 2.36), and WHO clinical staging 3 (HR 1.987; 95%CI 0.995 to 3.969) and 4 (HR 2.084; 95%CI 1.034 to 4.201). Subjects with virological failure had lower weight-for-age z-scores [median 1.92; interquartile range (IQR) -3.003 to -0.81] and height-for-age z-scores [median -2.05; IQR -2.902 to -1.04] at the time of failure. Conclusions In HIV-infected children treated without routine VL monitoring, age at diagnosis <60 months, severe immunodeficiency, WHO clinical stage 3 and 4, and referral from other centers were associated with virological failure.
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CiteScore
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