Multidisciplinary, inpatient directly observed therapy for HIV-1-infected children and adolescents failing HAART: A retrospective study
Multidisciplinary, inpatient directly observed therapy for HIV-1-infected children and adolescents failing HAART: A retrospective study
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DOI：
10.1089/apc.2006.20.275
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发表时间：
2006-04-01
影响因子：
4.9
通讯作者：
Hutton, N
中科院分区：
文献类型：
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作者：
Parsons, GN;Siberry, GK;Hutton, N
HIV-1感染和病毒载量升高的儿童和青少年有疾病进展的风险。当门诊坚持治疗的努力未能降低病毒载量时，我们选择住院患者进行直接观察的抗逆转录病毒治疗。对2000年12月1日至2003年12月1日因依从性问题而入住康复机构的患者进行了回顾性病历审查。使用Wilcoxon符号秩检验评价入院时、出院前和出院后6个月的CD 4计数和病毒载量差异。19例住院患者纳入分析。与入院时的平均CD 4计数（262）相比，出院时的平均CD 4计数（492）和出院后6个月的平均CD 4计数（429）显著较高（分别为p < 0.001和p = 0.01）。CD 4百分比变化也观察到类似结果。与入院时的平均病毒载量（log 5.7）相比，出院时（log 4.7）和出院后6个月（log 5）的平均病毒载量显著降低（p < 0.001和p < 0.004）。大多数入院（74%）涉及高效抗逆转录病毒治疗（HAART）方案的变化。总之，对病毒载量升高和不依从的HIV-1感染儿童和青少年住院接受直接观察治疗可立即持续（长达6个月）降低病毒载量和增加CD 4计数。
Children and adolescents with HIV-1 infection and elevated viral loads are at risk for disease progression. When outpatient adherence efforts fail to reduce viral loads, we have chosen to hospitalize patients for directly observed antiretroviral therapy. A retrospective chart review was performed for patients who were admitted for adherence concerns to a rehabilitation facility from December 1, 2000 to December 1, 2003. Differences in CD4 count and viral load at admission, prior to discharge and 6 months after discharge were evaluated using the Wilcoxon signed-ranks test. Nineteen admissions were included in the analysis. Compared to the mean CD4 count at admission (262), the mean CD4 counts at discharge (492) and 6 months after discharge (429) were significantly higher (p < 0.001 and p = 0.01, respectively). Similar results were observed for change in CD4 percentage. Compared to the mean viral load at admission (log 5.7), the mean viral loads at discharge (log 4.7) and 6 months after discharge (log 5) were significantly lower (p < 0.001 and p < 0.004). The majority of admissions (74%) involved a change in highly active antiretroviral therapy (HAART) regimen. In conclusion, hospitalization for directly observed therapy of HIV-1-infected children and adolescents with elevated viral loads and nonadherence resulted in an immediate and sustained (up to 6 months) reduction in viral load and increase in CD4 count.