Analysis Of Antiretroviral Therapy Effect And 90-90-90 Strategic Goal Prediction In Children With HIV/AIDS In Guangxi

Background:Antiretroviral therapy(ART)is currently the most effective therapy for inhibiting HIV infection.However,as the treatment lasted longer,many problems such as treatment failure and adverse drug reactions occur.It is required to evaluate the treatment effect in order to adjust the drug regimen in time.In 2014,the UNAIDS/WHO proposed the "90-90-90" target.It is essential to regularly assess the progress of countries and regions in achieving the "90-90-90" target.Many HIV-infected children still face challenges in achieving the "90-90-90" goal of HIV-positive children.Objective: Through the investigation and follow-up of AIDS patients who received ART in Guangxi from 2004 to 2017,grasp the basic characteristics,clinical characteristics,treatment status and follow-up status;understand the treatment effect and survival status of ART,and explore the virology and immunity after ART treatment Influencing factors of academic treatment effect and survival time;evaluating the progress of "90-90-90" goal of Guangxi.The aim is to propose comprehensive prevention measures for children with AIDS in Guangxi,and to provide a scientific reference for improving the treatment effect and survival status of children.Methods: Collecting the basic information and treatment information of children with AIDS who received antiviral treatment in 2004-2017 in Guangxi through the comprehensive AIDS prevention and control information system.The information includes demographic characteristics,WHO clinical stage,baseline viral load,baseline CD4+T count,baseline opportunistic infection,and initial treatment.Analyzing the cumulative virological failure rate,immunological failure rate,survival rate and survival curve of subjects with different characteristics by the Kaplan-Meier method;and analyzing the virological and immunological treatment effects and survival time after antiviral treatment Influencing factors by the Cox proportional hazard model.Using the ARIMA and Holt exponential smoothing models to predict the number of CLHIV in 2019 and 2021,the number of CLHIV diagnosed,the number of CLHIV diagnosed and receiving ART,and the number of CLHIV that achieve viral suppression,and calculate the progress of "90-90-90".Results1.Basic characteristics: In total,847 HIV/AIDS patients were included in the retrospective cohort study.The sex ratio of men to women was 1.1: 1.The main route of infection was mother-to-child transmission(95.3%).WHO clinical stage is mainly stage I(53.5%).The total opportunistic infection rate was 17.4%,including: persistent or intermittent fever for 1 month(7.0%),tuberculosis(5.1%),thrush(1.4%),persistent diarrhea(>2 weeks)(1.3%),Skin damage(1.3%).There were a total of 82 children who changed the first-line drug regimen due to drug toxicity and side effects.2.Virological failure and its influencing factors: Of the 847 study subjects,in total of 764 HIV/AIDS patients were at least one follow-up viral load record.A total of 186 patients(24.3%)had virological failures.At the 12 th,24th,48 th,72th,96 th,120th,and 144 th months,the cumulative virological failure rates of the subjects were 14.8%,18.7%,22.0%,24.7%,28.4%,30.7%,and 39.3%.In the multivariate Cox proportional hazards model,the number of baseline opportunistic infections is 2 or more(HR=3.85,95%CI:1.94-7.67),and the baseline CD4+T cell count is 200-350/μL(HR=1.68,95%CI: 1.07-2.63),the initial treatment plan is 2NRTIs+1PI(HR=2.79,95% CI: 2.06-3.78),poor drug compliance(HR=1.48,95%CI:1.07-2.05)and drug replacement(HR=2.46,95%CI:1.80-3.35)have a higher risk of virological failure(P <0.05).3.Immunology and influencing factors of failure: Of the 847 study subjects,in total of 782 HIV/AIDS patients were at least one follow-up CD4 record.At the 12 th,24th,48 th,72th,96 th,120th,132 th months,the cumulative immunological failure rates of the subjects were 10.7%,14.5%,21.4%,28.8%,32.6%,36.4%,and 37.6%.In the multivariate Cox proportional hazards model,baseline CD4+T cell counts>500/μL(HR=7.99,95%CI: 5.04-12.68)and baseline HCV infection(HR=2.22,95%CI: 1.03-4.78),Children who did not experience virological suppression(HR=2.46,95% CI: 1.80-3.35)during follow-up have a higher risk of immunological failure(P<0.05).4.Survival outcome and its influencing factors: 41 patients were died,with a mortality rate of 4.8%(41/847),of which 24 died of AIDS-related diseases,accounting for 58.5% of all deaths.After starting ART,the cumulative survival rates at the 12 th,24th,48 th,72th,and 84 th months were 98.1%,97.8%,97.2%,96.9%,and 96.6%,respectively.In a multivariate Cox regression analysis,pediatric patients whose baseline WHO clinical stage was stage IV were 3.12 times more likely to die after ART treatment than patients with stage I(HR=3.12,95%CI: 1.02-9.56);relative to baseline children with CD4+T cell counts>500cells/μL and those with CD4 cell levels <200/μL were 3.81 times more likely to die(HR=4.05,95%CI: 1.05-13.80).5.Reflect the state indicator of the startup ART: Children aged over 1 year old,from 2004 to 2006,the median percentage of CD4% was 13.62(IQR:7.09-26.88),from 2007 to 2011 was 16.38(IQR: 4.56-29.64),from 2012 It was24.08(IQR: 11.47-43.43)by 2015 and 25.30(IQR: 6.05-47.38)from 2016 to2018.The difference of CD4% in different groups was statistically significant.6.Progress on the targets of “90-90-90”: By the end of 2017,79.68% of all CLHIV in Guangxi knew their HIV status,78.75% of those diagnosed had initiated ART,and 91.89% of those on ART have durable viral suppression.Using ARIMA model and the ES model for prediction,and the results showed that by the end of 2019,82.71% of all CLHIV in Guangxi will know their HIV status,84.50% of those diagnosed will have ART,and 85.68% of those who have initiated ART will receive durable viral suppression;by the end of 2021,93.51% of all CLHIV in Guangxi will know their HIV status,84.28% of those diagnosed will have initiated ART,and 85.83% of those on ART will receive durable viral suppression.Conclusions: AIDS patients under the age of 15 in Guangxi are mainly mother-to-child transmission.The treatment effect of ART in AIDS patients achieves good effect,and effective measures should be taken to monitor patients’ VL level,CD4 level,and opportunistic infections during treatment.At the same time,choose the treatment plan carefully,strengthen medicine and compliance education,and dynamically understand the patient’s medication.According to the predicted results,it is still difficult for Guangxi to achieve the "90-90-90" target of WHO/UNAIDS on CLHIV by 2021,and the implementation of HIV prevention and control strategies still needs to be strengthened.