Non-Nucleoside Reverse Transcriptase Inhibitore-Based Antiretroviral Therapy in Perinatally HIV-Infected, Treatment-Naive Adolescents in Asia
Non-Nucleoside Reverse Transcriptase Inhibitore-Based Antiretroviral Therapy in Perinatally HIV-Infected, Treatment-Naive Adolescents in Asia
复制标题
DOI：
10.1016/j.jadohealth.2015.11.006
复制
发表时间：
2016-04-01
影响因子：
7.6
通讯作者：
Kariminia, Azar
中科院分区：
文献类型：
--
作者：
Boettiger, David C.;Sudjaritruk, Tavitiya;Kariminia, Azar
目的：大约三分之一未经治疗的围产期艾滋病毒感染儿童会进入青春期。我们评估了基于非核苷逆转录酶抑制剂 (NNRTI) 的抗逆转录病毒疗法 (ART) 在此人群中的持久性和有效性。方法：对 10-19 岁、接受过基于 NNRTI 的 ART 且随访时间大于等于 6 个月的围产期 HIV 感染、未接受过抗逆转录病毒治疗的患者的数据进行了分析。竞争风险回归用于评估 NNRTI 替代和临床失败（世界卫生组织 3/4 期事件或死亡）的预测因素。病毒抑制被定义为5年随访期间病毒载量为80%。 NNRTI 替代和临床失败的发生率分别为每 100 名患者年 4.9 次和 1.4 次。在 ART 开始时不使用复方新诺明预防与 NNRTI 替代相关（风险比 [HR]，1.5 与使用；95% 置信区间 [CI] = 1.0-2.2；p = 0.05）。基线 CD4+ 计数 200； 95% CI = 1.2-8.9； p = .02）和在 ART 开始时不使用复方新诺明预防（HR，2.1 vs. 使用；95% CI = 1.0-4.6；p = .05）均与临床失败相关。 结论：尽管 ART 开始较晚，青少年仍取得了良好的追赶性生长率、CD4+ 计数恢复率和病毒学抑制率。在该人群中尽早开始 ART 治疗并常规预防复方新诺明可能有助于降低目前 NNRTI 替代率和临床失败率。 (C) 2016 年青少年健康与医学协会。版权所有。
Purpose: About a third of untreated, perinatally HIV-infected children reach adolescence. We evaluated the durability and effectiveness of non-nucleoside reverse-transcriptase inhibitor (NNRTI)-based antiretroviral therapy (ART) in this population.Methods: Data from perinatally HIV-infected, antiretroviral-naive patients initiated on NNRTI-based ART aged 10-19 years who had >= 6 months of follow-up were analyzed. Competing risk regression was used to assess predictors of NNRTI substitution and clinical failure (World Health Organization Stage 3/4 event or death). Viral suppression was defined as a viral load 80% up to 5 years of follow-up. NNRTI substitution and clinical failure occurred at rates of 4.9 and 1.4 events per 100 patient-years, respectively. Not using cotrimoxazole prophylaxis at ART initiation was associated with NNRTI substitution (hazard ratio [HR], 1.5 vs. using; 95% confidence interval [CI] = 1.0-2.2; p = .05). Baseline CD4+ count 200; 95% CI = 1.2-8.9; p = .02) and not using cotrimoxazole prophylaxis at ART initiation (HR, 2.1 vs. using; 95% CI = 1.0-4.6; p = .05) were both associated with clinical failure.Conclusions: Despite late ART initiation, adolescents achieved good rates of catch-up growth, CD4+ count recovery, and virological suppression. Earlier ART initiation and routine cotrimoxazole prophylaxis in this population may help to reduce current rates of NNRTI substitution and clinical failure. (C) 2016 Society for Adolescent Health and Medicine. All rights reserved.