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首页> 外文期刊>Journal of AIDS and HIV Research >Evaluating an enhanced adherence intervention among HIV positive adolescents failing atazanavir/ritonavir-based second line antiretroviral treatment at a public health clinic
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Evaluating an enhanced adherence intervention among HIV positive adolescents failing atazanavir/ritonavir-based second line antiretroviral treatment at a public health clinic

机译：在公共卫生诊所评估在基于atazanavir / ritonavir的二线抗逆转录病毒治疗失败的HIV阳性青少年中加强依从性干预的情况

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Sustaining virological suppression among HIV-infected adolescents is challenging. We evaluated a home-based adherence intervention and characterized self-reported adherence, virological response and drug resistance among adolescents failing atazanavir/ritonavir (ATV/r)-based 2nd line treatment. Methods: HIV-positive adolescents (10-18 years) on ATV/r-based 2nd line treatment with virological failure (viral load (VL) ≥1 000 copies/ml) were randomized to either standard care (SC) or SC with addition of modified directly administered antiretroviral therapy (mDAART) for 90 days. VL was measured and questionnaires were administered at study entry and at 3 months. Genotyping was done for participants with continued failure. Primary outcome was suppression to VL 180 days were enrolled, 23(46%) were randomized to mDAART and 27(54%) to SC. Fifty-four percent were female; mean age was 15.8 years; mean baseline VL was 4.8(log10) copies/ml; 40% reported adherence <80% in previous 1 month at baseline; 40% suppressed (VL <1 000 copies/ml) after follow-up. mDAART resulted in significantly increased self-reported adherence (RR= 0.1; 95% CI=0.02-0.8, p=0.023); closely following dosing schedule (RR= 4.8; 95% CI=1.6-13.8, p=0.004); VL decrease (p=0.031) and modest increase in virological suppression to <1 000 copies/ml (p=0.105). Genotyping in 28/30 participants with continued virological failure demonstrated high level atazanavir resistance (I50L, N88S and I84V) in 6(21%); 3(11%) of whom also had high level resistance to lopinavir and darunavir (V32I, I50L, I54V, 147V and V82A). Discussion: The mDAART intervention modestly improved virological suppression among adolescents with ATV/r-based 2nd line treatment failure, significantly increased self-reported adherence and decreased viral load. High level ATV/r resistance was demonstrated. Conclusion: Targeting mDAART to adolescents who are virologically failing PI-based 2nd line treatment decreases viral load and increases self-reported adherence. Early drug-resistance testing could reduce morbidity and mortality.
机译：要在受HIV感染的青少年中维持病毒学抑制作用具有挑战性。我们评估了基于家庭的依从性干预措施，并表征了在基于阿扎那韦/利托那韦（ATV / r）的二线治疗失败的青少年中自我报告的依从性，病毒学应答和耐药性。方法：将接受ATV / r为基础的二线治疗且病毒学衰竭（病毒载量（VL）≥1000拷贝/ ml）的HIV阳性青少年（10-18岁）随机分为标准护理（SC）或加用SC修改后的直接给药抗逆转录病毒疗法（mDAART），持续90天。在研究开始时和3个月时测量VL并进行问卷调查。对持续失败的参与者进行了基因分型。主要结局是抑制VL 180天，其中23（46％）被随机分配至mDAART，27（54％）被随机分配至SC。 54％为女性;平均年龄为15.8岁;平均基线VL为4.8（log10）拷贝/ ml; 40％的患者在基线前1个月内的依从性<80％;随访后抑制了40％（VL <1000拷贝/ ml）。 mDAART导致自我报告的依从性显着提高（RR = 0.1; 95％CI = 0.02-0.8，p = 0.023）;严格遵循给药时间表（RR = 4.8; 95％CI = 1.6-13.8，p = 0.004）; VL降低（p = 0.031），病毒学抑制作用适度增加至<1000拷贝/ ml（p = 0.105）。 28/30持续病毒学失败的参与者的基因分型显示出6（21％）的高水平阿扎那韦耐药性（I50L，N88S和I84V）;其中3个（11％）对洛匹那韦和达那那韦（V32I，I50L，I54V，147V和V82A）也有高水平的耐药性。讨论：mDAART干预适度改善了基于ATV / r的二线治疗失败的青少年的病毒学抑制作用，显着提高了自我报告的依从性并降低了病毒载量。证明了高水平的ATV / r抵抗力。结论：将mDAART靶向病毒学上基于PI的二线治疗未能通过病毒治疗的青少年，可减少病毒载量并增加自我报告的依从性。早期的耐药性测试可以降低发病率和死亡率。

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