de Martino M, Tovo P A, Balducci M, Galli L, Gabiano C, Rezza G, Pezzotti P
Department of Pediatrics, University of Florence, via Luca Giordano 13, I-50132 Florence, Italy.
JAMA. 2000 Jul 12;284(2):190-7. doi: 10.1001/jama.284.2.190.
Since the introduction of combined antiretroviral therapy, mortality rates in adults with human immunodeficiency virus type 1 (HIV-1) infection have decreased. However, little information is available outside the setting of controlled trials on survival of perinatally HIV-infected children treated with antiretroviral therapy.
To assess effect of availability of antiretroviral therapy on decreasing mortality in perinatally HIV-infected children.
Population-based, multicenter longitudinal study involving data collected by the Italian Register for HIV Infection in Children.
A network of 106 pediatric clinical centers.
A total of 1142 children born between November 1980 and December 1997 with perinatally acquired HIV infection with a median follow-up of 5.9 years.
Time to HIV-related death calculated for birth cohort and calendar period and grouped by distribution of predominant type of antiretroviral therapy administered over time.
Survival was longer in the 1996-1997 birth cohort (crude relative hazard [RH] of death, 0.39; 95% confidence interval [CI], 0.15-0.96) and 1996-1998 calendar period (crude RH of death, 0.65; 95% CI, 0.45-0.95) than in birth cohort and calendar period 1980-1995, but not when adjusted for maternal antiretroviral treatment during pregnancy and clinical condition at time of delivery, gestational age, and birth weight (adjusted RH of death, 0.55; 95% CI, 0.20-1.50, for birth cohort; and adjusted RH of death, 0.71, 95% CI, 0.43-1.16, for calendar period). In a multivariate model with 1980-1995 as comparison, the 1996-1997 birth cohort had an RH of 0.57 (95% CI, 0.22-1.47; P=.27) but RH for calendar period 1996-1998 was 0.63 (95% CI, 0.47-0.85; P<. 01). When the effects of birth cohort, calendar period, and type of antiretroviral therapy were evaluated simultaneously in the same model, the RH of death was not significantly different from 1.0 for the 1996-1997 birth cohort (P=.19) and calendar period 1996-1998 (P=. 83) suggesting a causal relationship between decreased risk of death and use of combination therapy. The RH of death in children receiving monotherapy or double or triple combination therapy was 0. 77 (95% CI, 0.55-1.08), 0.70 (95% CI, 0.42-1.17), and 0.29 (95% CI, 0.13-0.67), respectively, vs no antiretroviral therapy.
Survival of perinatally HIV-infected children improved in 1996-1998 as a result of the introduction of combined antiretroviral therapies. JAMA. 2000;284:190-197
自联合抗逆转录病毒疗法问世以来，1型人类免疫缺陷病毒（HIV-1）感染成人的死亡率有所下降。然而，在对照试验环境之外，关于接受抗逆转录病毒疗法的围产期感染HIV儿童的生存情况，几乎没有可用信息。
评估抗逆转录病毒疗法的可及性对降低围产期感染HIV儿童死亡率的影响。
基于人群的多中心纵向研究，涉及意大利儿童HIV感染登记处收集的数据。
106个儿科临床中心组成的网络。
共有1142名在1980年11月至1997年12月间出生、围产期感染HIV的儿童，中位随访时间为5.9年。
按出生队列和日历时间段计算HIV相关死亡时间，并根据随时间推移主要抗逆转录病毒疗法的分布进行分组。
1996 - 1997年出生队列（死亡的粗相对风险[RH]为0.39；95%置信区间[CI]为0.15 - 0.96）和1996 - 1998日历时间段（死亡的粗RH为0.65；95% CI为0.45 - 0.95）的生存时间长于1980 - 1995年出生队列和日历时间段，但在对孕期母亲抗逆转录病毒治疗、分娩时的临床状况、胎龄和出生体重进行调整后并非如此（出生队列调整后的死亡RH为0.55；95% CI为0.20 - 1.50；日历时间段调整后的死亡RH为0.71，95% CI为0.43 - 1.16）。在以1980 - 1995年为对照的多变量模型中，1996 - 1997年出生队列的RH为0.57（95% CI为0.22 - 1.47；P = 0.27），但1996 - 1998日历时间段的RH为0.63（95% CI为0.47 - 0.85；P < 0.01）。当在同一模型中同时评估出生队列、日历时间段和抗逆转录病毒疗法类型的影响时，1996 - 1997年出生队列（P = 0.19）和1996 - 1998日历时间段（P = 0.83）的死亡RH与1.0无显著差异，这表明死亡风险降低与联合疗法的使用之间存在因果关系。与未接受抗逆转录病毒疗法相比，接受单一疗法、双重或三重联合疗法的儿童死亡RH分别为0.77（95% CI为0.55 - 1.08）、0.70（95% CI为0.42 - 1.17）和0.29（95% CI为0.13 - 0.67）。
由于联合抗逆转录病毒疗法的引入，1996 - 1998年围产期感染HIV儿童的生存情况有所改善。《美国医学会杂志》。2000年；284：190 - 197
