Viral load care of HIV-1 infected children and adolescents: A longitudinal study in rural Zimbabwe.
Viral load care of HIV-1 infected children and adolescents: A longitudinal study in rural Zimbabwe.
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DOI：
10.1371/journal.pone.0245085
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发表时间：
2021
期刊：
影响因子：
3.7
通讯作者：
Katzenstein D
中科院分区：
文献类型：
--
作者：
Mapangisana T;Machekano R;Kouamou V;Maposhere C;McCarty K;Mudzana M;Munyati S;Mutsvangwa J;Manasa J;Shamu T;Bogoshi M;Israelski D;Katzenstein D
在撒哈拉以南非洲的农村社区保持对儿童和青少年抗逆转录病毒治疗的病毒学抑制是具有挑战性的。我们探索了在津巴布韦农村地区以差异化的社区服务提供模式中，将药物方案转换为基于蛋白酶抑制剂(PI)的治疗，并减少奈韦拉平和齐多夫定的使用。从2016年到2018年，我们在津巴布韦胡伦圭的奇达莫约基督教医院跟踪了306名儿童和青少年的抗逆转录病毒治疗，该医院在8个分散的农村社区外展地点提供紧凑的抗逆转录病毒疗法。病毒载量测试由罗氏进行(2016)，后续(2018)由护理点病毒载量分析进行。病毒学失败定义为病毒载量(Virus Load≥，1,000拷贝/ml)，用Logistic回归模型评估病毒学失败和失访的风险。在2016年的基线水平上，306名儿童和青少年中有296人(97%)接受了一线抗逆转录病毒治疗，只有10人接受了基于PI的方案。中位年龄为12岁(IQR8-15)，55%为女性。209例(68%)病毒载量被抑制(1,000拷贝/毫升)，97例(32%)未被抑制(病毒载量≥为1000)。在2018年随访时，42/306例(14%)被转移23例(7%)或LTFU 17例(6%)，2例死亡。2018年，在CARE保留的264人中，107/264人(41%)已改用二线利托那韦促进的PI，阿巴卡韦作为新的核苷酸类似物逆转录酶抑制剂(NRTI)。总体病毒载量抑制率从2016年的68%上升到2018年的81%(P<；0.001)。病毒载量测试，以及改用二线利托那韦和阿巴卡韦强化的PI，显著增加了津巴布韦农村艾滋病毒感染儿童和青少年的病毒学抑制。
Maintaining virologic suppression of children and adolescents on ART in rural communities in sub-Saharan Africa is challenging. We explored switching drug regimens to protease inhibitor (PI) based treatment and reducing nevirapine and zidovudine use in a differentiated community service delivery model in rural Zimbabwe. From 2016 through 2018, we followed 306 children and adolescents on ART in Hurungwe, Zimbabwe at Chidamoyo Christian Hospital, which provides compact ART regimens at 8 dispersed rural community outreach sites. Viral load testing was performed (2016) by Roche and at follow-up (2018) by a point of care viral load assay. Virologic failure was defined as viral load ≥1,000 copies/ml. A logistic regression model which included demographics, treatment regimens and caregiver’s characteristics was used to assess risks for virologic failure and loss to follow-up (LTFU). At baseline in 2016, 296 of 306 children and adolescents (97%) were on first-line ART, and only 10 were receiving a PI-based regimen. The median age was 12 years (IQR 8–15) and 55% were female. Two hundred and nine (68%) had viral load suppression (<1,000 copies/ml) and 97(32%) were unsuppressed (viral load ≥1000). At follow-up in 2018, 42/306 (14%) were either transferred 23 (7%) or LTFU 17 (6%) and 2 had died. In 2018, of the 264 retained in care, 107/264 (41%), had been switched to second-line, ritonavir-boosted PI with abacavir as a new nucleotide analog reverse transcriptase inhibitor (NRTI). Overall viral load suppression increased from 68% in 2016 to 81% in 2018 (P<0.001). Viral load testing, and switching to second-line, ritonavir-boosted PI with abacavir significantly increased virologic suppression among HIV-infected children and adolescents in rural Zimbabwe.
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