Immuno-virological response and associated factors amongst HIV-1 vertically infected adolescents in Yaoundé-Cameroon.
Immuno-virological response and associated factors amongst HIV-1 vertically infected adolescents in Yaoundé-Cameroon.
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DOI：
10.1371/journal.pone.0187566
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发表时间：
2017
期刊：
影响因子：
3.7
通讯作者：
Njom Nlend AE
中科院分区：
文献类型：
--
作者：
Fokam J;Billong SC;Jogue F;Moyo Tetang Ndiang S;Nga Motaze AC;Paul KN;Njom Nlend AE
有限的研究报告了资源有限环境（RLS）中携带艾滋病毒（ALWHIV）的青少年终生抗逆转录病毒治疗（ART）的结果，从而将这一人群归类为服务不足人群。因此，我们旨在确定喀麦隆ALWHIV的免疫学和病毒学反应以及相关因素。2016年1月至5月，在喀麦隆雅温德萨的国家社会保险基金保健中心进行了一项横断面观察研究。免疫和病毒学反应分别通过CD4细胞计数和病毒载量进行评估，病毒抑制（VS）定义为<50拷贝/ml。通过自我报告过去14天内缺失剂量来评估依从性。数据采用R v.3.3.0进行分析，以p<0.05为差异有统计学意义。在纳入研究的145例接受ART治疗的ALWHIV中，52%为女性，中位年龄[四分位数（IQR）]为13[11-16]岁，中位接受ART治疗时间[IQR]为7[5-10]岁，48%为孤儿，92%接受一线ART治疗，36%坚持ART治疗。抗逆转录病毒治疗应答后，79%（114/145）患者CD4≥500/mm3, 71.0%（103/145）患者接受VS治疗，其中52.4%（76/145）患者持续接受VS治疗。抗逆转录病毒治疗持续时间与免疫恢复相关（奇数比3.73[1.26-12.21]），但与病毒学应答无关。父母双方的孤儿依从性差的风险更大（p = 0.078）。在喀麦隆的这个城市环境中，接受抗逆转录病毒治疗的艾滋病毒感染者在中期表现出良好的免疫和病毒学应答。对于抗逆转录病毒治疗的长期成功，实施密切监测依从性和病毒反弹的风险将是高度相关的，特别是对父母双方的孤儿。
Limited studies have reported the outcomes of lifelong antiretroviral therapy (ART) amongst adolescents living with HIV (ALWHIV) in resource-limited settings (RLS), thus classifying this population as underserved. We therefore aimed to ascertain the immunological and virological responses, and associated factors amongst Cameroonian ALWHIV. A cross-sectional and observational study was conducted from January through May 2016 at the National Social Insurance Fund Health Centre in Yaoundé-Cameroon. Immunological and virological responses were evaluated using CD4 cell count and viral load respectively, with viral suppression (VS) defined as <50 copies/ml. Adherence was evaluated using self-reported missing doses during the past 14 days. Data were analyzed using R v.3.3.0, with p<0.05 considered statistically significant. Of the 145 ALWHIV on ART enrolled in the study, 52% were female, median age [interquartile (IQR)] was 13 [11–16] years, median [IQR] time-on-ART was 7 [5–10] years, 48% were orphans, 92% were on first-line ART and 36% were adherent to ART. Following ART response, 79% (114/145) had CD4 ≥500/mm3, 71.0% (103/145) were on VS of whom 52.4% (76/145) had a sustained VS. Duration of ART was associated with immune restoration (Odd Ratio 3.73 [1.26–12.21]) but not with virological response. Risks of poor adherence were greater in orphans of both parents (p = 0.078). In this urban setting of Cameroon, ALWHIV receiving ART show favorable immunological and virological response in a medium run. For long-term ART success, implementing a close monitoring of adherence and risks of viral rebound would be highly relevant, especially for orphans of both parents.
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