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首页> 外文期刊>AIDS Research and Human Retroviruses >Treatment outcomes of HIV-infected adolescents attending public-sector HIV clinics across Gauteng and Mpumalanga, South Africa
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Treatment outcomes of HIV-infected adolescents attending public-sector HIV clinics across Gauteng and Mpumalanga, South Africa

机译：在南非豪登省和姆普马兰加省的公共部门艾滋病诊所接受艾滋病毒感染的青少年的治疗结果

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摘要

There is little evidence comparing treatment outcomes between adolescents and other age groups, particularly in resource-limited settings. A retrospective analysis of data from seven HIV clinics across urban Gauteng (n=5) and rural Mpumalanga (n=2), South Africa was conducted. The analysis compared HIV-positive antiretroviral treatment (ART)-naive young adolescents (10-14 years), older adolescents (15-19), and young adults (20-24 years) to adults (≥25 years) initiated onto standard first-line ART between April 2004 and August 2010. Log-binomial regression was used to estimate relative risk (RR) of failure to suppress viral load (≥400 copies/ml) or failure to achieve an adequate CD4 response at 6 or 12 months. The effect of age group on virological failure, mortality, and loss to follow-up (LTFU; ≥90 days since scheduled visit date) was estimated using Cox proportional hazards models. Of 42,427 patients initiating ART, 310 (0.7%) were young adolescents, 342 (0.8%) were older adolescents, and 1599 (3.8%) were young adults. Adolescents were similar to adults in terms of proportion male, baseline CD4 count, hemoglobin, and TB. Compared to adults, both older adolescents (6 months RR 1.75 95% CI 1.25-2.47) and young adults (6 months RR 1.33 95% CI 1.10-1.60 and 12 months RR 1.64 95% CI 1.23-2.19) were more likely to have an unsuppressed viral load and were more likely to fail virologically (HR 2.90 95% CI 1.74-4.86; HR 2.94 95% CI 1.63-5.31). Among those that died or were LTFU, the median time from ART initiation until death or LTFU was 4.7 months (IQR 1.5-13.2) and 10.9 months (IQR 5.0-22.7), respectively. There was no difference in risk of mortality by age category, compared to adults. Young adolescents were less likely to be LTFU at any time period after ART initiation (HR 0.43 95% CI 0.26-0.69) whereas older adolescents and young adults were more likely to be LTFU after ART initiation (HR 1.78 95% CI 1.34-2.36; HR 1.63 95% CI 1.41-1.89) compared to adults. HIV-infected adolescents and young adults between 15 and 24 years have poorer ART treatment outcomes in terms of virological response, LTFU, and virological failure than adults receiving ART. Interventions are needed to help improve outcomes and retention in care in this unique population.
机译：很少有证据比较青少年和其他年龄组之间的治疗效果，尤其是在资源有限的情况下。对来自南非豪登省（n = 5）和农村姆普马兰加省（n = 2）的七个艾滋病诊所的数据进行了回顾性分析。该分析比较了未接受HIV阳性抗逆转录病毒治疗（ART）的年轻青少年（10-14岁），年龄较大的青少年（15-19岁）和年轻人（20-24岁）与最初接受标准的成人（≥25岁）在2004年4月至2010年8月间进行抗逆转录病毒治疗。采用对数二项式回归来评估未能抑制病毒载量（≥400拷贝/ ml）或未能在6或12个月内获得足够的CD4反应的相对风险（RR）。使用Cox比例风险模型评估了年龄组对病毒学衰竭，死亡率和随访损失的影响（LTFU;自计划访视日起≥90天）。在开始接受抗逆转录病毒治疗的42,427例患者中，青少年为310（0.7％），年龄较大的青少年为342（0.8％），青少年为1599（3.8％）。在男性比例，基线CD4计数，血红蛋白和结核病方面，青少年与成年人相似。与成年人相比，年龄较大的青少年（6个月RR 1.75 95％CI 1.25-2.47）和年轻人（6个月RR 1.33 95％CI 1.10-1.60和12个月RR 1.64 95％CI 1.23-2.19）都更有可能未抑制的病毒载量，更可能在病毒学上失败（HR 2.90 95％CI 1.74-4.86; HR 2.94 95％CI 1.63-5.31）。在那些死亡或为LTFU的患者中，从开始ART到死亡或LTFU的中位时间分别为4.7个月（IQR 1.5-13.2）和10.9个月（IQR 5.0-22.7）。与成年人相比，按年龄类别划分的死亡风险没有差异。接受抗逆转录病毒治疗后的任何时间段，青少年都不太可能成为LTFU（HR 0.43 95％CI 0.26-0.69），而接受抗逆转录病毒治疗后，较大的青少年和年轻人更容易成为LTFU（HR 1.78 95％CI 1.34-2.36;与成人相比，HR 1.63 95％CI 1.41-1.89）。在病毒学应答，LTFU和病毒学衰竭方面，受HIV感染的青少年和15至24岁的成年人比接受ART的成年人的ART治疗效果较差。需要采取干预措施来帮助改善这一独特人群的结果并保持其护理水平。

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