Two-Year Outcomes of Children on Non-Nucleoside Reverse Transcriptase Inhibitor and Protease Inhibitor Regimens in a South African Pediatric Antiretroviral Program
Two-Year Outcomes of Children on Non-Nucleoside Reverse Transcriptase Inhibitor and Protease Inhibitor Regimens in a South African Pediatric Antiretroviral Program
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DOI：
10.1097/inf.0b013e31817acf7b
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发表时间：
2008-11-01
影响因子：
3.6
通讯作者：
Boulle, Andrew M.
中科院分区：
文献类型：
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作者：
Jaspan, Heather B.;Berrisford, Alison E.;Boulle, Andrew M.
背景：撒哈拉以南非洲地区有限的艾滋病毒儿童治疗方案的有效性数据很少。方法：回顾性队列研究，评估开普敦一家诊所391名接受含有蛋白酶抑制剂（PI）或非核苷逆转录抑制剂（nNRTI）的高活性抗逆转录病毒方案（HAART）的儿童的临床和实验室结果。终点包括CD4%和计数、病毒载量、体重/年龄Z评分（WAZ）、生存率、药物变化和随访时间超过24个月的损失。使用广义估计方程群体平均模型来确定与病毒学抑制的关联，并使用log-rank检验来探索与生存的关联。结果：总体而言，尽管24个月时病毒学抑制仅为49%，但该队列的中位cd4比基线持续翻倍，中位WAZ稳定增加，生存率为91%。然而，当按方案分析时，含pi方案在所有时间点具有更好的病毒学抑制。两种治疗方案之间的免疫和生长终点或生存期没有差异。在预测任何持续时间为Lip至24个月的病毒学抑制的多变量模型中，并调整基线CD4%、方案、年龄、基线WAZ、HAART持续时间和HAART开始年份，基于nnrti的方案（优势比[OR]: 0.38； 95%可信区间[CI]: 0.19-0.77）和HAART持续时间与病毒学抑制呈负相关。年龄（OR: 1.23 /年；95% CI: 1.09-1.39）与病毒学抑制呈正相关。结论：在这种情况下，尽管PI方案比nNRTIs获得了更大的病毒学抑制，但HAART的益处是实质性的。需要进一步探索这些地区儿童的抗逆转录病毒治疗方案和剂量。
Background: Few data exist on the efficacy of the limited regimens for children with HIV, which are available in sub-Saharan Africa.Methods: Retrospective cohort study to evaluate the clinical and laboratory outcomes of 391 children who received protease inhibitor (PI) or non-nucleoside reverse transcription inhibitor (nNRTI)-containing highly active antiretroviral regimens (HAART) from a Cape Town clinic. Endpoints included CD4% and count, viral loads, weight-for-age Z score (WAZ), Survival, drug changes, and loss to follow-Lip over 24 months. A generalized estimating equation population-averaged model was used to identify associations with virological suppression, and a log-rank test explored associations with survival.Results: Overall, this cohort achieved a sustained doubling of median CD4% from baseline, steady increase of median WAZ, and survival of 91%, despite only 49% virologic suppression at 24 months. However, when analyzed according to regimen, PI-containing regimens had better virologic suppression at all time points. There were no differences in immunologic and growth endpoints between regimens or in survival. In a multivariate model predicting virologic suppression at any duration Lip to 24 months and adjusting for baseline CD4%, regimen, age, baseline WAZ, duration of HAART, and year of HAART initiation, nNRTI-based regimens (odds ratio [OR]: 0.38; 95% confidence interval [CI]: 0.19-0.77) and length of time on HAART were inversely associated with virologic Suppression. Age (OR: 1.23 per year; 95% CI: 1.09-1.39) was positively associated with virologic suppression.Conclusions: The benefits of HAART are substantial in this setting, although PI regimens achieved greater virologic suppression than nNRTIs. Further exploration of regimens and dosing of antiretrovirals for children in these settings is needed.