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Tenofovir, Lamivudine, and Dolutegravir Among Rural Adolescents in Zimbabwe: A Cautionary Tale
AIDS Research and Human Retroviruses ( IF 1.5 ) Pub Date : 2022-10-14 , DOI: 10.1089/aid.2021.0140
Vinie Kouamou 1 , Rhoderick Machekano 2 , Tichaona Mapangisana 2 , Caroline Maposhere 3 , Shungu Munyati 3 , Junior Mutsvangwa 3 , Tinei Shamu 4, 5, 6 , Kathy McCarty 7 , David Katzenstein 3 , Justen Manasa 8, 9
Affiliation  

Tenofovir disoproxil fumarate, lamivudine, and dolutegravir (TLD) as a safe and more effective single daily dose regimen is rolling out in Africa for people living with HIV. Although access to viral load (VL) testing is improving, patients may still be transitioned to TLD with virological failure and potential drug resistance. We reviewed annual VL test results of 390 children and adolescents who had enrolled in a community-based antiretroviral therapy program in rural Zimbabwe between 2018 and 2019. VL testing was done by the near point of care simplified amplification-based assays (Diagnostics for the Real World, Sunnyvale, CA, USA) at Chidamoyo Christian Hospital and rate of virological suppression (VS) on TLD (VL <1,000 copies/mL) was assessed. Overall, 184 children and adolescents on TLD were enrolled in this study. The median [interquartile range (IQR)] age was 15 (11–19) years, above half of the participants were female (57%). Before switching to TLD, rate of VS was 76% (139/184). After a median (IQR) duration of 6.9 (5.5–9.1) months on TLD, VS was observed in 95% (174/184) of the participants. Of the 10 participants with VL ≥1,000 copies/mL on TLD, 90% (9/10) were failing on their previous regimens, 6 of 9 (67%) having been on boosted protease inhibitor-based regimens. A high rate (95%) of VS was observed among children and adolescents on TLD in rural Zimbabwe. TLD may address the problems of virological failure and emergence of resistance in Africa. However, longer follow-up might be needed to ascertain sustained VS in this vulnerable population. Randomized Control Trial NCT03986099

中文翻译:

津巴布韦农村青少年中的替诺福韦、拉米夫定和多替拉韦:一个警示故事

富马酸替诺福韦二吡呋酯、拉米夫定和多替拉韦 (TLD) 作为一种安全且更有效的每日单剂量治疗方案正在非洲针对艾滋病毒感染者推出。尽管病毒载量 (VL) 检测的可及性正在改善,但患者仍可能因病毒学失败和潜在耐药性而转向 TLD。我们回顾了 2018 年至 2019 年间在津巴布韦农村参加基于社区的抗逆转录病毒治疗计划的 390 名儿童和青少年的年度 VL 检测结果。VL 检测是通过近点护理简化的基于扩增的检测(真实诊断)进行的。 World, Sunnyvale, CA, USA)在 Chidamoyo Christian Hospital 进行了研究,并评估了 TLD 的病毒学抑制率 (VS)(VL <1,000 拷贝/mL)。总体而言,184 名 TLD 儿童和青少年参加了本研究。中位[四分位距 (IQR)] 年龄为 15 (11–19) 岁,超过一半的参与者为女性 (57%)。在切换到 TLD 之前,VS 率为 76% (139/184)。TLD 的中位持续时间 (IQR) 为 6.9 (5.5–9.1) 个月后,95% (174/184) 的参与者观察到 VS。在 TLD 上 VL ≥1,000 拷贝/mL 的 10 名参与者中,90% (9/10) 的先前治疗方案失败,9 人中有 6 人 (67%) 接受了基于加强蛋白酶抑制剂的治疗方案。在津巴布韦农村地区的 TLD 儿童和青少年中,观察到 VS 的发生率很高 (95%)。TLD 可以解决非洲病毒学失败和耐药性出现的问题。然而,可能需要更长时间的随访才能确定这一弱势群体的持续 VS。随机对照试验 NCT03986099
更新日期:2022-10-19
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