Incidencia y factores de riesgo asociados al fallo terapéutico en pacientes pediátricos de 1 mes a 12 años de edad diagnosticados con VIH por transmisión vertical, en el período enero 2013 a diciembre 2020, en la unidad de atención integral pediátrica del Hospital Infantil Robert Reid Cabral

Abstract

[Español] Métodos: Se realizó un estudio descriptivo, retrospectivo de corte transversal, utilizando los expedientes clínicos de los pacientes de 1 mes a 12 años de edad que tenían como diagnóstico VIH por transmisión vertical asistidos en la Unidad de Atención Integral Pediátrica del Hospital Infantil Robert Reid Cabral en el período comprendido de enero 2013 a diciembre 2020. Resultados: Un total de 94 expedientes fueron revisados en el estudio, se encontró fallo terapéutico en 20 pacientes, obteniendo una incidencia 21.27% para el período de enero 2013 a diciembre 2020; 15/20 (75%) residen actualmente en Santo Domingo. Del total de estos pacientes, 55/94 (58.51%) cayeron en abandono en algún momento, necesitando todos 55/55 (100%) de algún cambio en la terapia antirretroviral. Se encontró que 48/94 (51%) de los pacientes habían sufrido de algún cambio en el esquema terapéutico, y para estos cambios los principales criterios utilizados fueron: el fallo terapéutico, disponibilidad de antirretroviral, efectos adversos, adherencia al tratamiento y tuberculosis, siendo el fallo terapéutico el más frecuente, correspondiente a 20/48 (41%) pacientes. Se mostró que 67/94 (71.27%) de los pacientes sufrió de alguna complicación, siendo las más frecuentes la neumonía adquirida en la comunidad, seguida de infecciones de piel y tejidos blandos y tuberculosis. Discusión: La incidencia de fallo terapéutico en República Dominicana, resultó ser menor en comparación con estudios similares. La mayoría de los cambios en la terapia antirretroviral se asociaron a factores de riesgo como el abandono del tratamiento, marcadores virológicos iniciales elevados y a la aparición de complicaciones, sin embargo, no se encontró una relación significativa con los niveles de marcadores inmunológicos.

[English] Methods: A descriptive, retrospective cross-sectional study was conducted using clinical records of patients between 1 month and 12 years of age who had HIV diagnosis by vertical transmission attended treatment at the Integrate Pediatric Care Unit at Robert Reid Cabral Children's Hospital from January 2013 to December 2020. Results: A total of 94 files were reviewed in the study, therapeutic failure was found in 20 patients, obtaining an incidence of 21.27% for the period from January 2013 to December 2020; 15/20 (75%) currently reside in Santo Domingo. Of the total of these patients, 55/94 (58.51%) fell into abandonment at some point, all needing 55/55 (100%) of some change in antiretroviral therapy. It was found that 48/94 (51%) of the patients had suffered from some change in the therapeutic scheme, and for these changes the main criteria used were: therapeutic failure, antiretroviral availability, adverse effects, adherence to treatment and tuberculosis. Therapeutic failure being the most frequent, corresponding to 20/48 (41%) patients. It was shown that 67/94 (71.27%) of the patients suffered from some complication, the most frequent being community-acquired pneumonia, followed by skin and soft tissue infections, and tuberculosis. Discussion: The incidence of therapeutic failure in the Dominican Republic turned out to be lower compared to similar studies. Most of the changes in antiretroviral therapy were associated with risk factors such as treatment abandonment, elevated initial virological markers, and the appearance of complications; however, no significant relationship was found with the levels of immunological markers.

[English] Methods: A descriptive, retrospective cross-sectional study was conducted using clinical records of patients between 1 month and 12 years of age who had HIV diagnosis by vertical transmission attended treatment at the Integrate Pediatric Care Unit at Robert Reid Cabral Children's Hospital from January 2013 to December 2020. Results: A total of 94 files were reviewed in the study, therapeutic failure was found in 20 patients, obtaining an incidence of 21.27% for the period from January 2013 to December 2020; 15/20 (75%) currently reside in Santo Domingo. Of the total of these patients, 55/94 (58.51%) fell into abandonment at some point, all needing 55/55 (100%) of some change in antiretroviral therapy. It was found that 48/94 (51%) of the patients had suffered from some change in the therapeutic scheme, and for these changes the main criteria used were: therapeutic failure, antiretroviral availability, adverse effects, adherence to treatment and tuberculosis. Therapeutic failure being the most frequent, corresponding to 20/48 (41%) patients. It was shown that 67/94 (71.27%) of the patients suffered from some complication, the most frequent being community-acquired pneumonia, followed by skin and soft tissue infections, and tuberculosis. Discussion: The incidence of therapeutic failure in the Dominican Republic turned out to be lower compared to similar studies. Most of the changes in antiretroviral therapy were associated with risk factors such as treatment abandonment, elevated initial virological markers, and the appearance of complications; however, no significant relationship was found with the levels of immunological markers.