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优化艾滋病毒感染儿童的抗逆转录病毒疗法:莱索托观察队列的经验

Vincent J Tukei¹, Nicole Herrera², Matseliso Masitha¹

¹Elizabeth Glaser Pediatric AIDS Foundation, Maseru, Lesotho.

|July 17, 2023

概括

莱索托艾滋病毒阳性儿童转换为最佳抗逆转录病毒疗法 (ART) 方案,包括多卢特格拉维尔 (DTG) 或洛皮纳维尔/里托纳维尔 (LPV/r),导致病毒抑制改善. 建议加强监测和患者跟踪,以进一步改善ART过渡后的结果.

科学领域:

儿童传染病儿童传染病
艾滋病毒/艾滋病治疗治疗
资源有限的环境中的公共卫生.

背景情况:

抗逆转录病毒疗法 (ART) 对于治疗儿童艾滋病毒至关重要.
过渡到新的,更有效的ART疗法,如多卢特格拉维尔 (DTG) 和洛皮纳维尔/里托纳维尔 (LPV/r) 是全球优先事项.
了解在莱索托等特定环境中这种转变的结果对于优化儿科艾滋病毒护理至关重要.

研究的目的:

描述艾滋病毒阳性儿童从较旧的ART疗法 (以efavirenz/nevirapine为基础) 过渡到莱索托的最佳DTG或LPV/r基础的ART.
在这个儿科队列中评估与ART过渡相关的病毒抑制,保留和挑战.
为改善儿科ART计划提供基于证据的建议.

主要方法:

研究了一组310名15岁以下的儿童,从2018年1月1日开始在莱索托21个卫生机构接受ART治疗.
在ART启动后的24个月内,追溯和前性地收集数据,涵盖人口统计,ART方案,病毒载量和挑战.
统计分析包括用频率和百分比来总结数据.

主要成果:

在研究结束时,出现了显著的转变:46.1%接受LPV/r-basedART,35.2%接受DTG-basedART,18.7%继续使用旧方案.
病毒抑制率因治疗方案而异:在具有病毒载荷数据的儿童中,DTG的94.7%, efavirenz的79.2%,LPV/r的66.0%.
在随访期间观察到高死亡率 (6.1%),随访失踪率 (13.2%) 和转移率 (23.9%).

结论:

在莱索托引入最佳的ART疗法为大多数儿童促进了成功的过渡,许多儿童实现了病毒抑制.
尽管取得了改进,但病毒载量监测和患者跟踪方面的挑战仍然存在,导致损失和低于最佳的结果.
建议包括加强病毒载量监测和患者跟踪系统,以提高儿童艾滋病毒管理中的ART结果.

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