High survival and treatment success sustained after two and three years of first-line ART for children in Cambodia.
High survival and treatment success sustained after two and three years of first-line ART for children in Cambodia.
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DOI：
10.1186/1758-2652-13-11
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发表时间：
2010-03-21
影响因子：
6
通讯作者：
Zachariah R
中科院分区：
文献类型：
--
作者：
Isaakidis P;Raguenaud ME;Te V;Tray CS;Akao K;Kumar V;Ngin S;Nerrienet E;Zachariah R
在资源有限的环境中，关于儿童抗逆转录病毒治疗（ART）的长期结果的记录仍然很少。本研究的目的是评估柬埔寨一个规划环境中接受抗逆转录病毒治疗的儿童的2年和3年生存率、CD4细胞进化和病毒学反应。接受一线抗逆转录病毒治疗至少24个月的儿童通过病毒载量检测和基因分型进行评估。我们使用Kaplan-Meier生存分析和Cox回归来确定与治疗失败相关的危险因素。在1168名登记的艾滋病毒阳性儿童中，670名（57%）在2003年1月至2007年12月期间开始接受抗逆转录病毒治疗。抗逆转录病毒治疗开始后24个月和36个月的生存率分别为0.93 （95% CI: 0.91-0.95）和0.91 （95% CI: 0.88-0.93）。5岁以上儿童的中位CD4增加在24个月时为704个细胞/mm3，在36个月时为737个细胞/mm3。5岁以下儿童在24个月和36个月时的中位数CD4百分比增长分别为15.2%和15%。130名儿童完成了至少24个月的抗逆转录病毒治疗，138名儿童完成了36个月的治疗：268名儿童中有128名（48%）是女性。接受抗逆转录病毒治疗的中位年龄为6岁。总体而言，22名儿童的病毒载量为1000拷贝/ml（意向-治疗分析成功率为86%），21名儿童中有21名出现突变，主要对拉米夫定和非核苷类逆转录酶抑制剂产生耐药性。24个月和36个月失败的危险因素分别是CD4计数低于严重免疫抑制阈值。在22名病毒载量为1000拷贝/毫升的儿童中，只有2名符合世界卫生组织的免疫失败标准（敏感性= 0.1）。在资源有限的环境中，儿童在接受抗逆转录病毒治疗2至3年后可维持良好的生存率、免疫功能恢复和病毒抑制。需要增加获得常规病毒学测量的机会，以便及时诊断治疗失败。
Long-term outcomes of antiretroviral therapy (ART) in children remain poorly documented in resource-limited settings. The objective of this study was to assess two-and three-year survival, CD4 evolution and virological response among children on ART in a programmatic setting in Cambodia. Children treated with first-line ART for at least 24 months were assessed with viral load testing and genotyping. We used Kaplan-Meier analysis for survival and Cox regression to identify risk factors associated with treatment failure. Of 1168 registered HIV-positive children, 670 (57%) started ART between January 2003 and December 2007. Survival probability was 0.93 (95% CI: 0.91-0.95) and 0.91 (95% CI: 0.88-0.93) at 24 and 36 months after ART initiation, respectively. Median CD4 gain for children aged over five years was 704 cells/mm3 at 24 months and 737 at 36 months. Median CD4 percentage gain for children under five years old was 15.2% at 24 months and 15% at 36 months. One hundred and thirty children completed at least 24 months of ART, and 138 completed 36 months: 128 out of 268 (48%) were female. Median age at ART initiation was six years. Overall, 22 children had viral loads of >1000 copies/ml (success ratio = 86% on intention-to-treat-analysis) and 21 of 21 presented mutations conferring resistance mostly to lamivudine and non-nucleoside reverse transcriptase inhibitors. Risk factors for failure after 24 and 36 months were CD4 counts below the threshold for severe immunosupression at those months respectively. Only two out of 22 children with viral loads of >1000 copies/ml met the World Health Organization immunological criteria for failure (sensitivity = 0.1). Good survival, immunological restoration and viral suppression can be sustained after two to three years of ART among children in resource-constrained settings. Increased access to routine virological measurements is needed for timely diagnosis of treatment failure.
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影响因子：
15.8
作者：
Mills EJ;Nachega JB;Bangsberg DR;Singh S;Rachlis B;Wu P;Wilson K;Buchan I;Gill CJ;Cooper C
通讯作者：
Cooper C
影响因子：
3.8
作者：
Fassinou, P;Elenga, N;Msellati, P
通讯作者：
Msellati, P
影响因子：
8
作者：
Ghaffari, G;Passalacqua, DJ;Sleasman, JW
通讯作者：
Sleasman, JW
影响因子：
3.8
作者：
Rouet, Francois;Fassinou, Patricia;Msellati, Philippe
通讯作者：
Msellati, Philippe
影响因子：
120.7
作者：
de Martino, M;Tovo, PA;Pezzotti, P
通讯作者：
Pezzotti, P