Immunologic and virologic failure after first-line NNRTI-based antiretroviral therapy in Thai HIV-infected children.
Immunologic and virologic failure after first-line NNRTI-based antiretroviral therapy in Thai HIV-infected children.
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DOI：
10.1186/1742-6405-8-40
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发表时间：
2011-10-26
影响因子：
2.2
通讯作者：
Ananworanich J
中科院分区：
文献类型：
--
作者：
Bunupuradah T;Puthanakit T;Kosalaraksa P;Kerr S;Boonrak P;Prasitsuebsai W;Lumbiganon P;Mengthaisong T;Phasomsap C;Pancharoen C;Ruxrungtham K;Ananworanich J
在使用非核苷类逆转录酶抑制剂（NNRTI）为基础的高效抗逆转录病毒治疗（HAART）的亚洲HIV感染儿童中，免疫学和病毒学失败的数据有限。我们研究了免疫学失败（IF）和病毒学失败（VF）的发生率，以及使用IF预测VF在泰国HIV感染儿童中使用一线基于NNRTI的HAART的准确性。纳入了2001-2008年期间接受基于NNRTI的HAART治疗的2个前瞻性队列中的抗逆转录病毒（ART）初治HIV感染儿童。每12周进行一次CD 4计数，每24周测量一次血浆HIV-RNA。免疫恢复定义为CD4%≥ 25%。IF定义为基线时CD4%<15%的儿童中CD4%持续下降≥5%或CD 4计数较基线下降≥30%。VF定义为HAART治疗至少24周后HIV-RNA> 1，000拷贝/ml。使用配对t检验评估临床和实验室参数变化，并使用事件发生时间方法评估VF的预测因素。计算IF对VF的敏感性和特异性。纳入了107名ART初治HIV感染儿童，52%为女性，% CDC临床分类N：A：B：C 4：44：30：22%。基线数据为中位（IQR）年龄6.2（4.2-8.9）岁，CD4% 7（3-15），HIV-RNA 5.0（4.9-5.5）log 10拷贝/ml。分别有70%和30%的患者开始使用奈韦拉平（NVP）和依法韦仑（EFV）为基础的HAART。在96周时，没有人进展到CDC的艾滋病临床分类，一人死于肺炎。总体而言，观察到年龄别体重z评分（p = 0.014）、年龄别身高z评分、血红蛋白和CD 4显著改善（均p < 0.001）。第96周时的中位（IQR）CD 4%为25（18-30）%。89%的儿童免疫功能恢复（CD4%≥25%），75%的儿童HIV-RNA <1.7log10copies/ml。35例（32.7%）儿童在96周内发生VF。其中，24例（68.6%）和31例（88.6%）儿童分别在前24周和前48周发生VF。仅1例（0.9%）患儿在96周内发生IF，IF对VF的敏感性（95%CI）为4（0.1-20.4）%，特异性为100（93.9-100）%。此处定义的免疫失败与VF相比敏感性较低，不建议用于检测治疗失败。应在第24周和第48周进行两次血浆HIV-RNA检测，以检测早期治疗失败。Clinicaltrials.gov标识号NCT 00476606
There are limited data of immunologic and virologic failure in Asian HIV-infected children using non-nucleoside reverse transcriptase inhibitor (NNRTI)-based highly active antiretroviral therapy (HAART). We examined the incidence rate of immunologic failure (IF) and virologic failure (VF) and the accuracy of using IF to predict VF in Thai HIV-infected children using first-line NNRTI-based HAART. Antiretroviral (ART)-naïve HIV-infected children from 2 prospective cohorts treated with NNRTI-based HAART during 2001-2008 were included. CD4 counts were performed every 12 weeks and plasma HIV-RNA measured every 24 weeks. Immune recovery was defined as CD4%≥25%. IF was defined as persistent decline of ≥5% in CD4% in children with CD4%<15% at baseline or decrease in CD4 count ≥30% from baseline. VF was defined as HIV-RNA>1,000 copies/ml after at least 24 weeks of HAART. Clinical and laboratory parameter changes were assessed using a paired t-test, and a time to event approach was used to assess predictors of VF. Sensitivity and specificity of IF were calculated against VF. 107 ART-naive HIV-infected children were included, 52% female, % CDC clinical classification N:A:B:C 4:44:30:22%. Baseline data were median (IQR) age 6.2 (4.2-8.9) years, CD4% 7 (3-15), HIV-RNA 5.0 (4.9-5.5) log10copies/ml. Nevirapine (NVP) and efavirenz (EFV)-based HAART were started in 70% and 30%, respectively. At 96 weeks, none had progressed to a CDC clinical classification of AIDS and one had died from pneumonia. Overall, significant improvement of weight for age z-score (p = 0.014), height for age z-score, hemoglobin, and CD4 were seen (all p < 0.001). The median (IQR) CD4% at 96 weeks was 25 (18-30)%. Eighty-nine percent of children had immune recovery (CD4%≥25%) and 75% of children had HIV-RNA <1.7log10copies/ml. Thirty five (32.7%) children experienced VF within 96 weeks. Of these, 24 (68.6%) and 31 (88.6%) children had VF in the first 24 and 48 weeks respectively. Only 1 (0.9%) child experienced IF within 96 weeks and the sensitivity (95%CI) of IF to VF was 4 (0.1-20.4)% and specificity was 100 (93.9-100)%. Immunologic failure, as defined here, had low sensitivity compared to VF and should not be recommended to detect treatment failure. Plasma HIV-RNA should be performed twice, at weeks 24 and 48, to detect early treatment failure. Clinicaltrials.gov identification number NCT00476606
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影响因子：
3.8
作者：
Beck, Eduard J.;Vitoria, Marco;Souteyrand, Yves
通讯作者：
Souteyrand, Yves
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：
3.6
作者：
Puthanakit, Thanyawee;Aurpibul, Linda;Sirisanthana, Virat
通讯作者：
Sirisanthana, Virat
影响因子：
2
作者：
Gray, Diane;Nuttall, James;Zar, Heather
通讯作者：
Zar, Heather
影响因子：
3
作者：
Huffam, S. E.;Srasuebkul, P.;Ditangco, R.
通讯作者：
Ditangco, R.