Viral load monitoring and antiretroviral treatment outcomes in a pediatric HIV cohort in Ghana.
Viral load monitoring and antiretroviral treatment outcomes in a pediatric HIV cohort in Ghana.
复制标题
加纳小儿艾滋病毒队列中的病毒负荷监测和抗逆转录病毒治疗结果。
DOI：
10.1186/s12879-016-1402-9
复制
发表时间：
2016-02-03
影响因子：
3.7
通讯作者：
Paintsil E
中科院分区：
文献类型：
--
作者：
Kukoyi O;Renner L;Powell J;Barry O;Prin M;Kusah J;Cong X;Paintsil E
由于缺乏常规病毒载量监测，撒哈拉以南非洲地区感染艾滋病毒的儿童可能面临很高的风险，继续使用失败的一线治疗方案，并产生耐药性艾滋病毒变异。我们研究了在病毒载量没有常规监测的情况下，累积病毒载量（以病毒血症拷贝年（VCY）衡量）是否可以预测发病率。这是一项在加纳阿克拉Korle-Bu教学医院儿科HIV/AIDS护理项目中开始抗逆转录病毒治疗（ART）的HIV感染儿童的单中心前瞻性观察纵向研究。主要结果是以住院率、机会性感染率和门诊病人就诊率衡量的发病率。主要解释变量是病毒载量，以VCY表示。该研究包括140名儿童，他们在2009年9月至2013年5月期间开始接受ART治疗，并至少进行了2次病毒载量测量。有184人住院，肺炎是最常见的原因（22.8%）。共记录了102例机会性感染，结核病是最常见的机会性感染（68%）。共记录了823例门诊病人就诊，上呼吸道感染（14.2%）是最常见的原因。44%的研究参与者的VCY>4 log 10。与VCY <4 log 10的儿童相比，该子队列中的儿童患病就诊频率更高（p = 0.03）。根据WHO临床和免疫治疗失败标准，只有6.5%的VCY>4 log 10的儿童被确定为治疗失败。高水平的累积病毒载量可能转化为病毒学失败和随后的全因发病率增加。我们发现VCY在儿科的潜在效用值得进一步研究。VCY可能是常规病毒载量测量的一个很好的替代方法，因为它的测定可能不那么频繁，并且可以个性化以节省成本。
HIV-infected children in sub-Saharan Africa may be at a high risk of staying on a failing first-line regimen and developing drug-resistance HIV variants due to lack of routine viral load monitoring. We investigated whether cumulative viral load, measured as viremia copy-years (VCY) could predict morbidity in a setting where viral load is not routinely monitored. This was a single-center prospective observational longitudinal study of HIV-infected children initiating antiretroviral therapy (ART) at the Pediatric HIV/AIDS Care program at Korle-Bu Teaching Hospital in Accra, Ghana. The main outcome was morbidity measured as frequency of hospitalizations, opportunistic infections, and outpatient sick visits. The main explanatory variable was viral load measured as VCY. The study included 140 children who initiated ART between September 2009 and May 2013 and had at least 2 viral load measurements. There were 184 hospitalizations, with pneumonia being the most common cause (22.8 %). A total of 102 opportunistic infections was documented, with tuberculosis being the most common opportunistic infection (68 %). A total of 823 outpatient sick visits was documented, with upper respiratory infections (14.2 %) being the most common cause. Forty-four percent of our study participants had >4 log10 VCY. Children in this sub-cohort had a higher frequency of sick visits compared with those with <4 log10 VCY (p = 0.03). Only 6.5 % of children with >4 log10 VCY had been identified as treatment failure using WHO clinical and immunological treatment failure criteria. High level of cumulative viral load may translate to virological failure and subsequent increased all-cause morbidity. Our finding of potential utility of VCY in pediatrics warrants further investigations. VCY may be a good alternate to routine viral load measurement as its determination may be less frequent and could be personalized to save cost.