Time to First-Line ART Failure and Time to Second-Line ART Switch in the IeDEA Pediatric Cohort.
Time to First-Line ART Failure and Time to Second-Line ART Switch in the IeDEA Pediatric Cohort.
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DOI：
10.1097/qai.0000000000001667
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发表时间：
2018-06-01
期刊：
影响因子：
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通讯作者：
Yiannoutsos CT
中科院分区：
文献类型：
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作者：
Wools-Kaloustian K;Marete I;Ayaya S;Sohn AH;Van Nguyen L;Li S;Leroy V;Musick BS;Newman JE;Edmonds A;Davies MA;Eboua FT;Obama MT;Yotebieng M;Sawry S;Mofenson LM;Yiannoutsos CT
在全球范围内，估计180万艾滋病毒感染儿童中有49%正在接受抗逆转录病毒治疗。关于一线抗逆转录病毒治疗方案的长期持久性和过渡到二线治疗的时间的数据有限。本分析纳入了在30个亚太和非洲国家的208个地点之一开始其第一次抗逆转录病毒疗法治疗的2-14岁儿童，这些国家参加了儿科国际流行病学数据库评估艾滋病联盟。关注的结果为：一线ART治疗失败（临床、免疫学或病毒学）、转为二线治疗和自然减员（死亡或计划失败[LTP]）。计算了一线治疗失败和二线治疗启动的累积发生率，并将损耗作为竞争事件。在27，031名儿童中，开始抗逆转录病毒治疗的中位年龄为6.7岁。≤5岁儿童的中位基线CD4%为13.2%，>5岁儿童的CD 4计数为258个细胞/μl。几乎所有患者（94.4%）开始使用非核苷类逆转录酶抑制剂（NNRTI），5.3%使用蛋白酶抑制剂（PI），0.3%使用三核苷（NRTI）方案。一年时，7.7%失败，14.4%经历了磨损;到五年时，累积发生率分别为25.9%和29.4%。在ART失败后一年，13.7%的患者转为二线治疗，11.2%的患者经历了自然减员;到五年时，累积发生率分别为31.6%和25.9%。在开始抗逆转录病毒治疗后五年内，儿童的一线治疗失败率和自然减员率很高。在符合失败标准的儿童中，只有三分之一在五年内过渡到二线ART。
Globally, 49% of the estimated 1.8 million children living with HIV are accessing antiretroviral therapy (ART). There are limited data concerning long-term durability of first-line ART regimens and time to transition to second-line. Children initiating their first ART regimen between 2–14 years of age and enrolled in one of 208 sites in 30 Asia-Pacific and African countries participating in the Pediatric International Epidemiology Databases to Evaluate AIDS consortium were included in this analysis. Outcomes of interest were: First-line ART failure (clinical, immunologic, or virologic), change to second-line, and attrition (death or loss to program [LTP]). Cumulative incidence was computed for first-line failure and second-line initiation, with attrition as a competing event. In 27,031 children, median age at ART initiation was 6.7 years. Median baseline CD4% for children ≤5 years was 13.2% and CD4 count for those >5 years was 258 cells/µl. Almost all (94.4%) initiated a non-nucleoside reverse transcriptase inhibitor (NNRTI); 5.3% a protease inhibitor (PI), and 0.3% a triple nucleoside (NRTI)–based regimen. At one year, 7.7% had failed and 14.4% had experienced attrition; by five years, the cumulative incidence was 25.9% and 29.4%, respectively. At one year after ART failure, 13.7% had transitioned to second-line and 11.2% had experience attrition; by five years, the cumulative incidence was 31.6% and 25.9%, respectively. High rates of first-line failure and attrition were identified in children within five years after ART initiation. Of children meeting failure criteria, only one-third were transitioned to second-line ART within five years.