Challenges to achieving and maintaining viral suppression among children living with HIV

被引：14

作者：

Kakkar, Fatima ^{[1
,2
]}

Lee, Terry ^{[3
]}

Hawkes, Michael T. ^{[4
]}

Brophy, Jason ^{[5
]}

Lindy, Samson ^{[5
]}

Singer, Joel ^{[3
]}

Dieumegard, Hinatea ^{[2
,6
]}

Sauve, Laura ^{[7
]}

Alimenti, Ariane ^{[7
]}

Vaudry, Wendy ^{[4
]}

Seigel, Sandra ^{[8
]}

Tan, Ben ^{[9
]}

Karatzios, Christos ^{[2
,10
]}

Lamarre, Valerie ^{[1
,2
]}

Read, Stanley ^{[11
]}

Soudeyns, Hugo ^{[2
,6
]}

Bitnun, Ari ^{[11
]}

机构：

[1] Univ Montreal, CHU St Justine, Dept Pediat, Div Infect Dis, Montreal, PQ, Canada

[2] Univ Montreal, CHU St Justine, Dept Pediat, CIME, Montreal, PQ, Canada

[3] Univ British Columbia, Canadian HIV Trials Network, CIHR, Vancouver, BC, Canada

[4] Univ Alberta, Stollery Childrens Hosp, Dept Pediat, Div Infect Dis, Edmonton, AB, Canada

[5] Univ Ottawa, Childrens Hosp Eastern Ontario, Dept Pediat, Div Infect Dis, Ottawa, ON, Canada

[6] Univ Montreal, Dept Microbiol Infect Dis & Immunol, Fac Med, Montreal, PQ, Canada

[7] Univ British Columbia, BC Womens & Childrens Hosp, Dept Pediat, Div Infect Dis, Vancouver, BC, Canada

[8] McMaster Childrens Hosp, Dept Pediat, Div Pediat Med, Hamilton, ON, Canada

[9] Univ Saskatchewan, Div Infect Dis, Saskatoon, SK, Canada

[10] McGill Univ, Hlth Ctr, Div Infect Dis, Montreal, PQ, Canada

[11] Univ Toronto, Hosp Sick Children, Dept Pediat, Div Infect Dis, Toronto, ON, Canada

来源：

AIDS | 2020年 / 34卷 / 05期

基金：

加拿大健康研究院;

关键词：

combination antiretroviral therapy; HIV; pediatric; viral rebound; viral suppression; ANTIRETROVIRAL THERAPY; INFECTED CHILDREN; VIROLOGICAL FAILURE; PHARMACOKINETICS; ADHERENCE; CARE;

D O I：

10.1097/QAD.0000000000002454

中图分类号：

R392 [医学免疫学]; Q939.91 [免疫学];

学科分类号：

100102 ;

摘要：

Objectives: The objective of this study was to determine the time to, and durability of, viral suppression, among Canadian children living with HIV after initiation of combination antiretroviral therapy (cART). Design: Prospective, multicenter Canadian cohort study (Early Pediatric Initiation Canada Child Cure Cohort), using both prospective and retrospectively collected data. Methods: Kaplan-Meir survival estimates with Cox regression were used to determine the time to and risk factors for viral suppression, defined as two consecutive undetectable viral loads (<50 copies/ml) at least 30 days apart after initiation of cART. Results: A total of 228 children were enrolled between December 2014 and December 2018. The time to viral suppression was significantly shorter among children initiating cART after 5 <= 5 vs. years or less of age [adjusted hazard ratio (aHR) 1.57, 95% confidence interval (CI) 1.13-2.20], among those born after 2010 vs. prior (aHR 1.71, 95% CI 1.04-2.79), and among those without child protection services involvement (aHR 1.44, 95% CI 1.03-2.01). Overall, 27% of children had a viral rebound within 3 years of achieving viral suppression; the risk of viral rebound was significantly lower among children initiating cART after 5 vs. 5 years or less of age [adjusted odds ratio (aOR): 0.32, 95% CI 0.13-0.81], those whose families had not received social assistance (aOR 0.16, 95% CI 0.06-0.46), and females vs. males (aOR 0.51, 95% CI 0.26-0.99). Conclusion: Only 73% of the children in the Early Pediatric Initiation Canada Child Cure Cohort had maintained viral suppression 3 years after it was first achieved. Age at cART initiation, and socioeconomic factors were predictors of both time to viral suppression and risk of viral rebound in this cohort.

引用

页码：687 / 697

页数：11

共 30 条

[1]

[Anonymous], 2019, GUID US ANT AG PED H

[2]

Bitnun A., 2019, Clin. Infect. Dis

[3] Suboptimal Viral Suppression Rates Among HIV-Infected Children in Low- and Middle-Income Countries: A Meta-analysis [J].

Boerma, Ragna S. ;

Boender, T. Sonia ;

Bussink, Anton P. ;

Calis, Job C. J. ;

Bertagnolio, Silvia ;

de Wit, Tobias F. Rinke ;

van Hensbroek, Michael Boele ;

Sigaloff, Kim C. E. .

CLINICAL INFECTIOUS DISEASES, 2016, 63 (12) :1645-1654

[4]

Clayden P, 2018, PEDIAT ANTIRETROVAL

[5] Long-term response to combination antiretroviral therapy in HIV-infected children in the Netherlands registered from 1996 to 2012 [J].

Cohen, Sophie ;

Smit, Colette ;

van Rossum, Annemarie M. C. ;

Fraaij, Pieter L. A. ;

Wolfs, Tom F. W. ;

Geelen, Sibyl P. M. ;

Schoelvinck, Elisabeth H. ;

Warris, Adilia ;

Scherpbier, Henriette J. ;

Pajkrt, Dasja .

AIDS, 2013, 27 (16) :2567-2575

[6]

Cruz Maria L.S., 2014, J. Pediatr. (Rio J.), V90, P563, DOI 10.1016/j.jped.2014.04.007

[7] Targeting 90-90-90-don't leave children and adolescents behind [J].

Davies, Mary-Ann ;

Pinto, Jorge .

JOURNAL OF THE INTERNATIONAL AIDS SOCIETY, 2015, 18 :1-6

[8] A national review of vertical HIV transmission [J].

Forbes, John C. ;

Alimenti, Ariane M. ;

Singer, Joel ;

Brophy, Jason C. ;

Bitnun, Ari ;

Samson, Lindy M. ;

Money, Deborah M. ;

Lee, Terry C. K. ;

Lapointe, Normand D. ;

Read, Stanley E. .

AIDS, 2012, 26 (06) :757-763

[9] Pharmacokinetics of antiretroviral therapy in HIV-1-infected children [J].

Fraaij, PLA ;

van Kampen, JJA ;

Burger, DM ;

de Groot, R .

CLINICAL PHARMACOKINETICS, 2005, 44 (09) :935-956

[10] HIV-1 virological remission lasting more than 12 years after interruption of early antiretroviral therapy in a perinatally infected teenager enrolled in the French ANRS EPF-CO10 paediatric cohort: a case report [J].

Frange, Pierre ;

Faye, Albert ;

Avettand-Fenoel, Veronique ;

Bellaton, Erianna ;

Descamps, Diane ;

Angin, Mathieu ;

David, Annie ;

Caillat-Zucman, Sophie ;

Peytavin, Gilles ;

Dollfus, Catherine ;

Le Chenadec, Jerome ;

Warszawski, Josiane ;

Rouzioux, Christine ;

Saez-Cirion, Asier .

LANCET HIV, 2016, 3 (01) :E49-E54

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