Predicting virologic failure among HIV-1-infected children receiving antiretroviral therapy in Tanzania: a cross-sectional study.
Predicting virologic failure among HIV-1-infected children receiving antiretroviral therapy in Tanzania: a cross-sectional study.
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预测坦桑尼亚接受抗逆转录病毒治疗的 HIV-1 感染儿童的病毒学失败：一项横断面研究。
DOI：
10.1097/qai.0b013e3181cf4882
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发表时间：
2010-08
期刊：
影响因子：
--
通讯作者：
Reddy EA
中科院分区：
文献类型：
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作者：
Emmett SD;Cunningham CK;Mmbaga BT;Kinabo GD;Schimana W;Swai ME;Bartlett JA;Crump JA;Reddy EA
资源有限环境中的许多艾滋病毒护理和治疗方案依赖于抗逆转录病毒治疗（ART）的临床和免疫学监测，但尚未评估该策略检测儿童病毒学失败（VF）的准确性。对在坦桑尼亚转诊中心接受ART治疗≥6个月的1-16岁HIV感染儿童的横断面样本进行临床分期、CD 4淋巴细胞测量、血浆HIV-1 RNA水平和全血细胞计数（CBC）。使用双变量和多变量分析确定与VF（HIV RNA ≥400拷贝/mL）的相关性;评估当前临床和免疫学指南在识别VF儿童方面的准确性。在206名儿童（中位年龄8.7岁，ART持续时间2.4年）中，65名（31.6%）在入组时表现出VF。临床和免疫学标准确定2（3.5%）的57名儿童VF一线治疗，表现出3.5%的敏感性和100%的特异性。VF与年龄较小、接受奈韦拉平与依法韦仑为基础的方案、CD4% <25%和医生记录的依从性不良相关（双变量分析p<0.05）;后两个因素在多变量logistic回归中仍然具有显著性。这项研究表明，临床和免疫学标准在识别儿童病毒学失败方面表现不佳。迫切需要在资源有限的环境中适用的测量HIV-1 RNA水平的负担得起的技术。
Many HIV care and treatment programs in resource-limited settings rely on clinical and immunologic monitoring of antiretroviral therapy (ART), but accuracy of this strategy to detect virologic failure (VF) among children has not been evaluated. A cross sectional sample of HIV-infected children aged 1-16 years on ART ≥6 months receiving care at a Tanzanian referral center underwent clinical staging, CD4 lymphocyte measurement, plasma HIV-1 RNA level, and complete blood count (CBC). Associations with VF (HIV RNA ≥400 copies/mL) were determined utilizing bivariable and multivariate analyses; accuracy of current clinical and immunologic guidelines in identifying children with VF was assessed. Of 206 children (median age 8.7 years, ART duration 2.4 years), 65 (31.6%) demonstrated VF at enrollment. Clinical and immunological criteria identified 2 (3.5%) of 57 children with VF on first-line therapy, exhibiting 3.5% sensitivity and 100% specificity. VF was associated with younger age, receipt of nevirapine vs. efavirenz-based regimen, CD4% <25%, and physician documentation of maladherence (p<0.05 on bivariable analysis); the latter two factors remained significant on multivariate logistic regression. This study demonstrates poor performance of clinical and immunologic criteria in identifying children with virologic failure. Affordable techniques for measuring HIV-1 RNA level applicable in resource-limited settings are urgently needed.