Pediatric response to second-line antiretroviral therapy in South Africa.
Pediatric response to second-line antiretroviral therapy in South Africa.
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DOI：
10.1371/journal.pone.0049591
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发表时间：
2012
期刊：
影响因子：
3.7
通讯作者：
Feeney ME
中科院分区：
文献类型：
--
作者：
Zanoni BC;Sunpath H;Feeney ME
随着资源有限地区儿童抗逆转录病毒治疗 (ART) 的普及，更多儿童可能会经历一线 ART 治疗失败。我们使用 2003 年 8 月至 2010 年 12 月在南非夸祖鲁-纳塔尔省 McCord 医院 Sinikithemba 诊所开始 ART 的 HIV 感染儿童的电子病历进行了回顾性队列分析。我们分析了因一线治疗失败而开始二线 ART 的儿童的所有记录。我们使用逻辑回归来比较基于蛋白酶抑制剂 (PI) 和基于非核苷逆转录酶抑制剂 (NNRTI) 的二线 ART 的病毒结果，控制一线 ART 的时间、性别以及 HIV 基因分型是否指导治疗方案的改变。在此期间开始 ART 的 880 名儿童中，80 名 (9.1%) 因中位 95 周（IQR 65-147 周）后一线 ART 治疗失败而转为二线 ART。其中 8 名 (10%) 失败者接受了基于 NNRTI 的二线 ART，所有这些失败者基于 PI 的一线治疗方案均失败。 70 人 (87.5%) 接受了基于 PI 的二线 ART，所有这些人基于 NNRTI 的一线治疗方案均失败。两名儿童 (2.5%) 接受非标准双重治疗作为二线 ART。更换 ART 方案六个月后，PI 组的病毒抑制率 (82%) 显着高于 NNRTI 组 (29%；p=0.003)。四十一名儿童 (51%) 在转用二线 ART 之前接受了基因型耐药性测试。有和没有基因型测试的儿童之间六个月的病毒抑制没有显着差异（p = 0.38）。 结论：与基于 PI 的二线 ART 相比，基于 NNRTI 的二线 ART 病毒学失败的风险较高。
With improved access to pediatric antiretroviral therapy (ART) in resource-limited settings, more children could experience first-line ART treatment failure. We performed a retrospective cohort analysis using electronic medical records from HIV-infected children who initiated ART at McCord Hospital's Sinikithemba Clinic in KwaZulu-Natal, South Africa, from August 2003 to December 2010. We analyzed all records from children who began second-line ART due to first-line treatment failure. We used logistic regression to compare viral outcomes in Protease Inhibitor (PI)-based versus Non-Nucleoside Reverse Transcriptase Inhibitor (NNRTI)-based second-line ART, controlling for time on first-line ART, sex, and whether HIV genotyping guided the regimen change. Of the 880 children who initiated ART during this time period, 80 (9.1%) switched to second-line ART due to therapeutic failure of first-line ART after a median of 95 weeks (IQR 65–147 weeks). Eight (10%) of the failures received NNRTI-based second-line ART, all of whom failed a PI-based first-line regimen. Seventy (87.5%) received PI-based second-line ART, all of whom failed a NNRTI-based first-line regimen. Two children (2.5%) received non-standard dual therapy as second-line ART. Six months after switching ART regimens, the viral suppression rate was significantly higher in the PI group (82%) than in the NNRTI group (29%; p = 0.003). Forty-one children (51%) were tested for genotypic resistance prior to switching to second-line ART. There was no significant difference in six month viral suppression (p = 0.38) between children with and without genotype testing. Conclusion: NNRTI-based second-line ART carries a high risk of virologic failure compared to PI-based second-line ART.
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预测坦桑尼亚接受抗逆转录病毒治疗的 HIV-1 感染儿童的病毒学失败：一项横断面研究。
DOI：
10.1097/qai.0b013e3181cf4882
发表时间：
2010-08
期刊：
Journal of acquired immune deficiency syndromes (1999)
影响因子：
--
作者：
Emmett SD;Cunningham CK;Mmbaga BT;Kinabo GD;Schimana W;Swai ME;Bartlett JA;Crump JA;Reddy EA
通讯作者：
Reddy EA
影响因子：
120.7
作者：
Coovadia, Ashraf;Abrams, Elaine J.;Kuhn, Louise
通讯作者：
Kuhn, Louise
影响因子：
158.5
作者：
Palumbo, Paul;Lindsey, Jane C.;Violari, Avy
通讯作者：
Violari, Avy
DOI：
10.1097/qai.0b013e3182060610
发表时间：
2011-03-01
期刊：
Journal of acquired immune deficiency syndromes (1999)
影响因子：
--
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
通讯作者：
International Epidemiologic Databases to Evaluate AIDS Southern Africa (IeDEA-SA) Collaboration
影响因子：
3.8
作者：
Blanche, Stephane;Bologna, Rosa;Spinosa-Guzman, Sabrina
通讯作者：
Spinosa-Guzman, Sabrina