Virologic failure and second-line antiretroviral therapy in children in South Africa--the IeDEA Southern Africa collaboration.
Virologic failure and second-line antiretroviral therapy in children in South Africa--the IeDEA Southern Africa collaboration.
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DOI：
10.1097/qai.0b013e3182060610
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发表时间：
2011-03-01
期刊：
影响因子：
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通讯作者：
International Epidemiologic Databases to Evaluate AIDS Southern Africa (IeDEA-SA) Collaboration
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文献类型：
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作者：
Davies MA;Moultrie H;Eley B;Rabie H;Van Cutsem G;Giddy J;Wood R;Technau K;Keiser O;Egger M;Boulle A;International Epidemiologic Databases to Evaluate AIDS Southern Africa (IeDEA-SA) Collaboration
随着儿科抗逆转录病毒疗法的普及，儿童将开始经历治疗失败，需要二线治疗。我们评估了南非儿童病毒学失败和转换的概率和决定因素。对在7个南非治疗项目中开始ART的儿童的常规个体数据进行汇总分析，并进行6个月的病毒载量和CD 4监测，得出病毒学失败概率的Kaplan-Meier估计值（连续两次未抑制的病毒载量，第二次> 1，000拷贝/ml，治疗≥24周后）并转换为二线治疗。采用按程序分层的考克斯比例风险模型确定这些结局的预测因子。在5485名儿童中，3年病毒学失败的概率为19.3%（95%CI：17.6-21.1）。在初始治疗方案中单独使用奈韦拉平或利托那韦（与依法韦仑相比），以及暴露于预防母婴传播的治疗方案与治疗失败独立相关（校正的风险比（95%CI）分别为：1.77（1.11-2.83），2.39（1.57-3.64）和1.40（1.02-1.92））。在失败后随访≥1年的252名儿童中，38%转为二线治疗。失败与转换之间的中位（IQR）月数为5.7（2.9-11.0）。基于奈韦拉平或利托那韦作为单一蛋白酶抑制剂的三联ART似乎与更高的病毒学失败风险相关。病毒学上失败的儿童被调换的比例很低。
With expanding pediatric antiretroviral therapy (ART) access, children will begin to experience treatment failure and require second-line therapy. We evaluated the probability and determinants of virologic failure and switching in children in South Africa. Pooled analysis of routine individual data from children who initiated ART in 7 South African treatment programs with 6-monthly viral load and CD4 monitoring produced Kaplan-Meier estimates of probability of virologic failure (two consecutive unsuppressed viral loads with the second being >1,000 copies/ml, after ≥24 weeks of therapy) and switch to second-line. Cox proportional hazards models stratified by program were used to determine predictors of these outcomes. The 3-year probability of virologic failure among 5485 children was 19.3% (95%CI: 17.6–21.1). Use of nevirapine or ritonavir alone in the initial regimen (compared to efavirenz), and exposure to prevention of mother to child transmission regimens were independently associated with failure (adjusted hazard ratios (95%CI): 1.77(1.11–2.83), 2.39(1.57–3.64) and 1.40(1.02–1.92) respectively). Among 252 children with ≥1 year follow-up after failure, 38% were switched to second-line. Median (IQR) months between failure and switch was 5.7(2.9–11.0). Triple ART based on nevirapine or ritonavir as a single protease inhibitor appears to be associated with a higher risk of virologic failure. A low proportion of virologically failing children were switched.