Survival, plasma HIV-1 RNA concentrations and drug resistance in HIV-1-infected Haitian adolescents and young adults on antiretrovirals
Survival, plasma HIV-1 RNA concentrations and drug resistance in HIV-1-infected Haitian adolescents and young adults on antiretrovirals
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DOI：
10.2471/blt.07.050120
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发表时间：
2008-12-01
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影响因子：
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通讯作者：
Fitzgerald, Daniel W
中科院分区：
文献类型：
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作者：
Charles, Macarthur;Noel, Francine;Fitzgerald, Daniel W
目的评估海地青少年接受抗逆转录病毒治疗(ART)后的疗效。方法对2003年3月1日至2005年12月31日在海地太子港一家诊所就诊的13~25岁艾滋病患者进行抗逆转录病毒治疗(ART)后12个月的存活率、血浆HIV-1核糖核酸(RNA)浓度和HIV-1耐药性模式的评估。参与者根据世卫组织指南接受抗逆转录病毒治疗。用Kaplan-Meier分析评估从ART开始到死亡的生存概率及其95%可信区间(CI)。共发现146例患者，其中96例(66%)为女性；基线时CD4+T细胞计数的中位数为129个/ml。经Kaplan-Meier分析，13%的患者在12个月时死亡，17%在24个月时死亡，20%在36个月时死亡。在79例患者中，有40例(51%)在治疗12个月后血浆HIV-1RNA浓度为50拷贝/毫升，这与ART依从性差有关。在29例<1000拷贝/ml的12个月患者中，23例(79%)对非核苷类逆转录酶抑制剂(NNRTIs)耐药，21例(72%)同时对NNRTI和拉米夫定耐药，10例(35%)对NNRT1、拉米夫定和其他核苷类逆转录酶抑制剂耐药。106人(73%)报告了没有使用避孕套的性行为，其中35人(36%)在随访期间怀孕。结论接受抗逆转录病毒治疗的青少年和青年艾滋病患者存在病毒学失败和疾病进展的风险，因此可以将HIV-1传播给性伴侣和婴儿。迫切需要针对这一年龄段的特殊需要的战略。
Objective To assess outcomes after antiretroviral therapy (ART) in adolescents and youth in Haiti, a country with a generalized epidemic of infection with HIV-1.Methods An assessment was made of survival, plasma HIV-1 ribonucleic acid (RNA) concentrations and HIV-1 drug resistance patterns after 12 months of ART in patients aged 13-25 years who presented to a clinic in Port-au-Prince, Haiti, with AIDS between 1 March 2003 and 31 December 2005. Participants received ART in accordance with WHO guidelines. Kaplan-Meier analysis was used to estimate survival probabilities and their 95% confidence intervals (CI) for the period from ART initiation to death.Findings Of a total of 146 patients, 96 (66%) were female; the median CD4+ T-cell count at baseline was 129 cells/ml. By Kaplan-Meier analysis, 13% of the patients had died at 12 months, 17% at 24 months and 20% at 36 months. A plasma HIV-1 RNA concentration >= 50 copies/ml was seen in 40 (51%) of 79 patients 12 months after treatment initiation and was associated with poor ART adherence. Among 29 patients with > 1000 copies/ml at 12 months, resistance mutations to non-nucleoside reverse transcriptase inhibitors (NNRTIs) were detected in 23 cases (79%); to both NNRTIs and lamivudine in 21 (72%) cases; and to NNRTls, lamivudine and other nucleoside reverse transcriptase inhibitors in 10 (35%) cases. One hundred and six participants (73%) reported sexual intercourse without condoms, and 35 of the 96 Women (36%) were pregnant during follow-up.Conclusion Adolescents and youth with AIDS receiving ART are at risk of virologic failure and disease progression and can therefore transmit HIV-1 to sexual partners and infants. Strategies to target the special needs of this age group are urgently needed.