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首页> 外文期刊>AIDS >Impact of tuberculosis cotreatment on viral suppression rates among HIV-positive children initiating HAART.
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Impact of tuberculosis cotreatment on viral suppression rates among HIV-positive children initiating HAART.

机译：结核共治对发起HAART的HIV阳性儿童中病毒抑制率的影响。

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OBJECTIVE: To evaluate the association between treatment of HIV-tuberculosis (TB) coinfection and primary virologic failure among children initiating antiretroviral therapy in South Africa. DESIGN: We performed a retrospective cohort study of 1029 children initiating antiretroviral therapy at two medical centers in KwaZulu Natal, South Africa, a region of very high TB incidence. METHODS: Data were extracted from electronic medical records and charts and the impact of TB cotreatment on viral suppression at 6 and 12 months was assessed using logistic regression. RESULTS: The overall rate of virologic suppression (<400 HIV RNA copies/ml) was 85% at 6 months and 87% at 12 months. Children who received concurrent treatment for TB had a significantly lower rate of virologic suppression at 6 months (79 vs. 88%; P = 0.003). Those who received nonnucleoside reverse transcriptase inhibitor-based HAART had similar rates of viral suppression regardless of whether they received concurrent TB therapy. In contrast, children who received protease inhibitor-based HAART had significantly lower viral suppression rates at both 6 and 12 months if treated concurrently for TB (P = 0.02 and 0.03). Multivariate logistic regression revealed that age at initiation, protease inhibitor therapy, and TB coinfection were each independently associated with primary virologic failure. CONCLUSION: Concurrent treatment for TB is associated with lower rates of viral suppression among children receiving protease inhibitor-based HAART, but not among those receiving nonnucleoside reverse transcriptase inhibitor-based HAART. Guidelines for the care of young HIV-TB coinfected infants should be continually evaluated, as protease inhibitor-based antiviral therapy may not provide optimal viral suppression in this population.
机译：目的：评估在南非开始抗逆转录病毒疗法的儿童中艾滋病毒-结核合并感染与原发性病毒学衰竭之间的关联。设计：我们在结核病高发地区南非夸祖鲁纳塔尔的两个医疗中心对1029名开始接受抗逆转录病毒治疗的儿童进行了一项回顾性队列研究。方法：从电子病历和图表中提取数据，并使用logistic回归分析评估结核病联合治疗对6个月和12个月病毒抑制的影响。结果：病毒学抑制的总比率（<400 HIV RNA拷贝/ ml）在6个月时为85％，在12个月时为87％。接受结核病同时治疗的儿童在6个月时的病毒学抑制率明显较低（79比88％; P = 0.003）。那些接受基于非核苷逆转录酶抑制剂的HAART的病毒抑制率相似，无论他们是否同时接受TB治疗。相反，如果同时接受结核病治疗，则接受基于蛋白酶抑制剂的HAART的儿童在6个月和12个月时的病毒抑制率均显着降低（P = 0.02和0.03）。多因素logistic回归显示，起始年龄，蛋白酶抑制剂治疗和结核病合并感染分别与原发性病毒学衰竭相关。结论：同时接受结核病治疗与接受基于蛋白酶抑制剂的HAART的儿童中病毒抑制率较低相关，但接受基于非核苷逆转录酶抑制剂的HAART的儿童中与病毒抑制率较低相关。应继续评估年轻的HIV-TB合并感染婴儿的护理指南，因为基于蛋白酶抑制剂的抗病毒治疗可能无法在该人群中提供最佳的病毒抑制作用。

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