Gray L, Newell M L, Thorne C, Peckham C, Levy J
Institute of Child Health, University College, London, United Kingdom.
Pediatrics. 2001 Jul;108(1):116-22. doi: 10.1542/peds.108.1.116.
To describe patterns of clinical and immunologic progression in children who are vertically infected with the human immunodeficiency virus.
Children who were born to mothers who were infected with the human immunodeficiency virus in 11 European centers were enrolled at birth in a prospective study and followed according to a standard protocol. At each visit, a clinical and immunologic class was allocated according to guidelines of the Centers for Disease Control and Prevention (CDC). Progression to serious disease and death was assessed, allowing for available and actual antiretroviral therapy (ART). CDC class at each visit was assessed cross-sectionally.
More than 15% of infected children will have progressed to category C or death by age 1 year and nearly 50% by 10 years. Just under 20% of children will have evidence of severe immunodeficiency by age 1 and 75% by 10 years. In general, immune status poorly reflected clinical condition. Children who were born after 1994, when the recommendation of earlier initiation of more active therapy was introduced, were significantly less likely to progress than those who were born when treatment was not widely available or was largely confined to zidovudine monotherapy. Estimated progression to CDC class C or death initially was faster in untreated than in treated children, but by 10 years estimated cumulative progression was similar in both groups. Treatment started before class C disease was associated with significantly slower progression. Cross-sectional analysis showed that children largely are symptom-free throughout their lives. After 4 years of age, fewer than 25% of infected children had symptoms at any one time, irrespective of ART received.
Vertically infected children are without serious symptoms or signs for most of the time. The prognosis has improved with more widespread availability and use of combination ART. These findings have implications for health, education, and other support-service provision.
描述垂直感染人类免疫缺陷病毒的儿童的临床和免疫进展模式。
在11个欧洲中心，对母亲感染人类免疫缺陷病毒的儿童在出生时纳入一项前瞻性研究，并按照标准方案进行随访。每次就诊时，根据疾病控制和预防中心（CDC）的指南分配临床和免疫类别。评估进展为严重疾病和死亡的情况，同时考虑可用的和实际的抗逆转录病毒疗法（ART）。对每次就诊时的CDC类别进行横断面评估。
超过15%的受感染儿童在1岁时将进展为C类或死亡，到10岁时接近50%。不到20%的儿童在1岁时会有严重免疫缺陷的证据，到10岁时为75%。总体而言，免疫状态不能很好地反映临床状况。1994年之后出生的儿童，即在引入更早开始更积极治疗的建议之后出生的儿童，与那些在治疗尚未广泛可用或主要限于齐多夫定单药治疗时出生相比，进展的可能性显著降低。最初，未治疗儿童进展为CDC C类或死亡的估计速度比治疗儿童快，但到10岁时，两组的估计累积进展相似。在C类疾病之前开始治疗与进展明显较慢相关。横断面分析表明，儿童一生中大部分时间没有症状。4岁以后，无论接受何种ART，任何时候有症状的受感染儿童不到25%。
垂直感染的儿童大部分时间没有严重症状或体征。随着联合ART的更广泛可得和使用，预后有所改善。这些发现对健康、教育及其他支持服务的提供具有启示意义。
Zotero 插件