The case for viral load testing in adolescents in resource-limited settings.
The case for viral load testing in adolescents in resource-limited settings.
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DOI：
10.1002/jia2.25002
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发表时间：
2017-11
影响因子：
6
通讯作者：
Bekker LG
中科院分区：
文献类型：
--
作者：
Marcus R;Ferrand RA;Kranzer K;Bekker LG
全球艾滋病毒治疗方案的成功使大量感染了围产期艾滋病毒的儿童进入青春期。由于中低收入地区，特别是撒哈拉以南非洲的青少年艾滋病毒发病率居高不下，感染艾滋病毒的青少年人数正在进一步增加。虽然扩大获得艾滋病毒病毒载量监测的机会对于在整个艾滋病毒护理过程中实现90-90-90目标是必要的，但执行工作尚未完成。我们讨论了在青少年中优先监测病毒载量的理由和相关的挑战。感染艾滋病毒的青少年是一个难以成功治疗的复杂群体，因为围产期感染艾滋病毒的人广泛接受抗逆转录病毒治疗，而且这一年龄段的青少年在持续服药方面面临挑战。鉴于青少年治疗失败的风险很高，而且在有限的资源环境中可用的药物方案有限，监测青少年的艾滋病毒病毒载量可以防止病毒抑制的青少年转向不必要且代价高昂的二线治疗。由于艾滋病毒携带者的青少年可能有丰富的治疗经验，对治疗的依从性不佳，或者可能正在接受二线甚至三线治疗，因此病毒载量检测将使临床医生能够就增加对青少年的咨询和支持以及维持或更换治疗方案的必要性做出明智的决定。鉴于资源稀缺，可能需要在病毒学失败风险较高的人群中确定病毒载量检测的优先顺序。青少年的病毒学失败率高得不成比例，针对这一年龄段的病毒载量监测可能为更广泛的扩大提供宝贵的经验教训。
The success of HIV treatment programmes globally has resulted in children with perinatally acquired HIV reaching adolescence in large numbers. The number of adolescents living with HIV is growing further due to persisting high HIV incidence rates among adolescents in low‐ and middle‐income settings, particularly in sub‐Saharan Africa. Although expanding access to HIV viral load monitoring is necessary to achieve the 90‐90‐90 targets across the HIV care continuum, implementation is incomplete. We discuss the rationale for prioritizing viral load monitoring among adolescents and the associated challenges. Adolescents with HIV are a complex group to treat successfully due to extensive exposure to antiretroviral therapy for those with perinatally acquired HIV and the challenges in sustained medication adherence in this age group. Given the high risk of treatment failure among adolescents and the limited drug regimens available in limited resource settings, HIV viral load monitoring in adolescents could prevent unnecessary and costly switches to second‐line therapy in virologically suppressed adolescents. Because adolescents living with HIV may be heavily treatment experienced, have suboptimal treatment adherence, or may be on second or even third‐line therapy, viral load testing would allow clinicians to make informed decisions about increased counselling and support for adolescents together with the need to maintain or switch therapeutic regimens. Given scarce resources, prioritization of viral load testing among groups with a high risk of virological failure may be required. Adolescents have disproportionately high rates of virological failure, and targeting this age group for viral load monitoring may provide valuable lessons to inform broader scale‐up.
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影响因子：
3.7
作者：
Kyaw NT;Harries AD;Kumar AM;Oo MM;Kyaw KW;Win T;Aung TK;Min AC;Oo HN
通讯作者：
Oo HN
影响因子：
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作者：
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DOI：
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发表时间：
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影响因子：
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通讯作者：
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影响因子：
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作者：
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影响因子：
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作者：
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通讯作者：
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