Outcomes After Second-Line Antiretroviral Therapy in Children Living With HIV in Latin America.
Outcomes After Second-Line Antiretroviral Therapy in Children Living With HIV in Latin America.
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DOI：
10.1097/qai.0000000000002678
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发表时间：
2021-07-01
期刊：
影响因子：
--
通讯作者：
Rebeiro PF
中科院分区：
文献类型：
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作者：
Somerville K;Jenkins CA;Carlucci JG;Person AK;Machado DM;Luque MT;Pinto JA;Rouzier V;Friedman RK;McGowan CC;Shepherd BE;Rebeiro PF
对拉丁美洲感染艾滋病毒儿童的长期结果知之甚少。很少有研究探讨抗逆转录病毒治疗（ART）方案转换后，在这一人群中引入ART的几年。本研究旨在评估加勒比、中美洲和南美洲艾滋病毒流行病学网络（CCASAnet）中开始二线抗逆转录病毒治疗的儿童的临床结果。纳入了在CCASAnet内的站点转为二线抗逆转录病毒治疗的艾滋病毒感染儿童（<18岁）。使用竞争风险方法和考克斯模型评价了二线ART治疗期间病毒学失败、失访、其他主要ART治疗方案改变和全因死亡的累积发生率和相对风险。共有672名儿童开始接受二线抗逆转录病毒治疗。开始二线抗逆转录病毒治疗后3年，死亡的累积发生率为0.10（95%置信区间[CI] 0.08-0.13），失访为0.14（95% CI 0.11-0.17），主要方案改变为0.19（95% CI 0.15-0.22）。在改变治疗方案的患者中，35%是由于失败，11%是由于毒性/副作用。在有病毒载量数据的312名儿童中，3年时病毒学失败的累积发生率为0.62（95% CI 0.56-0.68）;至病毒学失败的时间与方案改变不相关（秩相关系数为-0.001; 95% CI-0.18，0.17）。在拉丁美洲，开始二线抗逆转录病毒治疗后的不良结局很常见。病毒学失败的高发生率及其与改变治疗方案的相关性差尤其令人担忧。需要作出更多努力，确保儿童获得最佳的抗逆转录病毒疗法。
Little is known about the long-term outcomes of children living with HIV in Latin America. Few studies have examined antiretroviral therapy (ART) regimen switches in the years following the introduction of ART in this population. This study aimed to assess clinical outcomes among children who started second-line ART in the Caribbean, Central and South America network for HIV epidemiology (CCASAnet). Children (<18 years old) with HIV who switched to second-line ART at sites within CCASAnet were included. The cumulative incidence and relative hazards of virologic failure while on second-line ART, loss to follow-up, additional major ART regimen changes, and all-cause mortality were evaluated using competing risks methods and Cox models. A total of 672 children starting second-line ART were included. Three years after starting second-line ART the cumulative incidence of death was 0.10 (95% confidence interval [CI] 0.08–0.13), loss to follow-up was 0.14 (95% CI 0.11–0.17), and major regimen change was 0.19 (95% CI 0.15–0.22). Of those changing regimens, 35% were due to failure and 11% to toxicities/side effects. Among the 312 children with viral load data, the cumulative incidence of virologic failure at 3 years was 0.62 (95% CI 0.56–0.68); time to virologic failure and regimen change were uncorrelated (rank correlation −0.001; 95% CI −0.18, 0.17). Poor outcomes after starting second-line ART in Latin America were common. The high incidence of virologic failure and its poor correlation with changing regimens was particularly worrisome. Additional efforts are needed to ensure children receive optimal ART regimens.
影响因子：
3.7
作者：
Zanoni BC;Sunpath H;Feeney ME
通讯作者：
Feeney ME