Williams A J, Duong T, McNally L M, Tookey P A, Masters J, Miller R, Lyall E G, Gibb D M
Department of Epidemiology and Public Health, Institute of Child Health, London, UK.
AIDS. 2001 Feb 16;15(3):335-9. doi: 10.1097/00002030-200102160-00006.
The outcome of Pneumocystis carinii pneumonia (PCP) in HIV-infected infants is poor, and the role of cytomegalovirus (CMV) co-infection in the course and outcome of PCP is unclear. This study describes the prevalence, clinical characteristics, management and changes in survival over time of vertically HIV-infected infants developing PCP and/or CMV infection.
Data on children with HIV, born in the UK and Ireland and reported to the National Study of HIV in Pregnancy and Childhood, with PCP and/or CMV were combined with clinical information collected from reporting paediatricians.
By April 1998, 340 vertically HIV-infected children had been reported, of whom 93 had PCP and/or CMV, as their first AIDS indicator disease; 85 (91%) were infants. Among infants with PCP, 79% were born to mothers not diagnosed as HIV infected, and there was an independent and statistically significant association with breast-feeding, being black African, and developing CMV disease. Median survival after PCP and/or CMV was significantly better in those born between 1993 and 1998 compared with those born before 1993 (P = 0.009), and worse than after other AIDS diagnoses (P = 0.01). Infants with dual infection were more likely to be ventilated (P = 0.003) and receive corticosteroids (P = 0.002) than those with PCP alone.
Although survival from PCP and CMV has improved over time, these remain serious and potentially fatal infections among infants in whom maternal HIV status is not recognized in pregnancy. Breast-feeding increases the risk of combined PCP and CMV infection, which is associated with severe disease.
感染人类免疫缺陷病毒（HIV）的婴儿患卡氏肺孢子虫肺炎（PCP）的预后较差，而巨细胞病毒（CMV）合并感染在PCP病程及预后中的作用尚不清楚。本研究描述了垂直感染HIV的婴儿发生PCP和/或CMV感染的患病率、临床特征、治疗及生存随时间的变化情况。
将在英国和爱尔兰出生并向全国妊娠及儿童HIV研究报告的患有PCP和/或CMV的HIV儿童数据，与从报告的儿科医生处收集的临床信息相结合。
截至1998年4月，已报告340例垂直感染HIV的儿童，其中93例将PCP和/或CMV作为其首个艾滋病指标疾病；85例（91%）为婴儿。在患有PCP的婴儿中，79%的母亲在孕期未被诊断为HIV感染，且母乳喂养、为非洲黑人以及发生CMV疾病与之存在独立且具有统计学意义的关联。1993年至1998年出生的婴儿在发生PCP和/或CMV后的中位生存期明显优于1993年之前出生的婴儿（P = 0.009），但比其他艾滋病诊断后的生存期更差（P = 0.01）。与仅患PCP的婴儿相比，双重感染的婴儿更有可能接受通气治疗（P = 0.003）和使用皮质类固醇（P = 0.002）。
尽管随着时间推移，PCP和CMV感染后的生存率有所提高，但在孕期未识别母亲HIV感染状况的婴儿中，这些感染仍然严重且可能致命。母乳喂养会增加PCP和CMV合并感染的风险，而这种合并感染与严重疾病相关。
