Preditores da falha do tratamento em crianças com HIV iniciando a terapia antirretrovírica de primeira linha no ensaio ODYSSEY
InfectologiaO que aconteceu
Os dados sobre os preditores de falência do tratamento em crianças que iniciam a terapêutica antirretroviral (TAR) são limitados, particularmente nos regimes com base em dolutegravir (DTG). ODYSSEY demonstrou eficácia superior do DTG versus padrão de cuidados (SOC). Foram avaliados preditores no início da TARV de falência do tratamento em 96 semanas.
O que encontraram
Three hundred and eighty-one children started first-line ART (82% African). At ART-initiation, median age was 10.5 years (IQR: 6.5, 14.0, 67 < 3 years), CD4% 20% (IQR: 12, 28), BMI-for-age Z-score -.58 (IQR:-1.48, +.25). One hundred and eighty-nine children started DTG, 192 started SOC (91% ≥3 years started efavirenz; 79% <3 years started lopinavir). Seventy-five children experienced treatment failure (24 DTG, 51 SOC). Failure risk was lower on DTG than SOC (hazard ratio [HR] = 0.47, 95% CI: 0.29-0.77, P = .002). Lower BMI-for-age Z-score (HR = 0.82 for each unit gain, 95% CI: 0.70-0.96, P = .01) and being at an African site (HR = 2.09, 95% CI: 0.82-5.31, P = .09) were associated with higher failure risk. Risk was also higher at younger ages with the steepest increase in the youngest children and increased at lower CD4%, with a stronger CD4% effect at younger ages. At CD4% = 20, HRs relative to age 10 years were 2.40 (95% CI: 1.58-3.65) at age 1 year, 1.30 (95% CI: 1.15-1.48) at age 5 years, and 0.80 (95% CI: 0.72-0.89) at age 18 years. At age 1 year, HRs relative to CD4% = 20 were 1.39 (95% CI: 1.16-1.66) at CD4% = 15, and 0.52 (95% CI: 0.36-0.75) at CD4% = 30; at age 10, corresponding estimates were 1.07 (95% CI: 0.94-1.20) at CD4% = 15, and 0.88 (95% CI: 0.69-1.13) at CD4% = 30.
Trecho mantido em inglês: a tradução automática não passou na conferência de números.
Por que isso importa
Idade jovem, baixo IMC-para-idade e CD4% baixo no início da TARV previram maior risco de falência do tratamento e podem orientar apoio direcionado.
Tradução automática do resumo original, publicado em Clinical infectious diseases : an official publication of the Infectious Diseases Society of America sob licença CC BY. Os números são conferidos contra o original; siglas e termos técnicos podem variar.
O estudo original
Predictors of Treatment Failure in Children With HIV Starting First-line Antiretroviral Therapy in the ODYSSEY Trial
James Wyncoll, Rujirek Kamolrattana, Moherndran Archary, Hilda A Mujuru, Adeodata R Kekitiinwa, Avy Violari, Sathaporn Na-Rajsima, Abbas Lugemwa, Ebrahim Variava, Mark F Cotton et al.
Descritores MeSH
- Heterocyclic Compounds, 3-Ring
- HIV Infections
- Anti-HIV Agents
- Alkynes
- Cyclopropanes
- Female
- Child, Preschool
- Humans
- Male
- Child