HIGH-FREQUENCY failure of combination antiretroviral therapy in paediatric HIV infection is associated with unmet maternal needs causing maternal NON-ADHERENCE
HIGH-FREQUENCY failure of combination antiretroviral therapy in paediatric HIV infection is associated with unmet maternal needs causing maternal NON-ADHERENCE
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DOI：
10.1016/j.eclinm.2020.100344
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发表时间：
2020-05-01
影响因子：
15.1
通讯作者：
Goulder, Philip
中科院分区：
文献类型：
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作者：
Millar, Jane R.;Bengu, Nomonde;Goulder, Philip
背景：早期联合抗逆转录病毒治疗（cART）可以减少儿童和成人HIV感染者的病毒库。极早期治疗的儿童可能有更高的治愈/缓解潜力。方法：在南非夸祖鲁-纳塔尔对151名宫内（IU）感染婴儿进行的一项观察性研究中，这些婴儿的治疗严格遵守国家指南，76名婴儿通过床旁（PART）检测确诊，在中位数26小时内启动了cART（IQR 18-38）和75名通过标准护理（SoC）实验室检测诊断的婴儿在第10天开始cART（IQR 8-13）。我们分析了死亡率，抑制病毒血症的时间，和aviraemia的维持在第一个2 years of life.Findings：基线血浆病毒载量低（中位数8000拷贝每毫升），与12%的婴儿有不可检测的病毒血症pre-cART启动。然而，只有三分之一（37%）的儿童在6个月内实现了病毒血症的抑制，并维持到>12个月。24%的患者在6个月内死亡或失访。婴儿死亡率为9.3%。IU-infected婴儿的高频率病毒学失败与传播或获得性耐药突变无关，但与cART不依从性相关（血浆cART检测不到/亚治疗，p
Background: Early combination antiretroviral therapy (cART) reduces the size of the viral reservoir in paediatric and adult HIV infection. Very early-treated children may have higher cure/remission potential.Methods: In an observational study of 151 in utero (IU)-infected infants in KwaZulu-Natal, South Africa, whose treatment adhered strictly to national guidelines, 76 infants diagnosed via point-of-care (PoC) testing initiated cART at a median of 26 h (IQR 18-38) and 75 infants diagnosed via standard-of-care (SoC) laboratory-based testing initiated cART at 10 days (IQR 8-13). We analysed mortality, time to suppression of viraemia, and maintenance of aviraemia over the first 2 years of life.Findings: Baseline plasma viral loads were low (median 8000 copies per mL), with 12% of infants having undetectable viraemia pre-cART initiation. However, barely one-third (37%) of children achieved suppression of viraemia by 6 months that was maintained to >12 months. 24% had died or were lost to follow up by 6 months. Infant mortality was 9.3%. The high-frequency virological failure in IU-infected infants was associated not with transmitted or acquired drug-resistant mutations but with cART non-adherence (plasma cART undetectable/subtherapeutic, p