Evans-Gilbert T, Pierre R, Steel-Duncan J C, Rodriguez B, Whorms S, Hambleton I R, Figueroa J P, Christie C D C
Kingston Paediatric and Perinatal HIV/AIDS Programme, Bustamante Hospital for Children, Jamaica.
West Indian Med J. 2004 Oct;53(5):322-6.
The study describes a cohort of HIV-infected Jamaican children receiving antiretroviral therapy (ART) and reports the outcome.
An observational prospective study was conducted on HIV-infected Jamaican children receiving anti retroviral drug therapy (ART). The outcome measures, weight, height, hospital admissions and length of stay were compared at initiation and within six months of commencing ART.
There were 37 (33.6%) of 110 HIV-infected children receiving ART during 2001 to 2003. The median age at commencement was six years (age range 1-16 years) with 54.1% (20) males and 48% AIDS orphans. Care was home-based for 68 % of all cases with the University Hospital of the West Indies managing 27 (73%) and the Bustamante Hospital for Children 10 (27%). The distribution by Centers for Disease Control and Prevention (CDC) clinical class was C (severely symptomatic), 22 (59.5%); B (moderately symptomatic), 8 (21.6%); A (mildly symptomatic), 6 (16.2%) and N (asymptomatic), one (2.7%). Among 14 (36%) children with CD4 counts, 8 (57%) were CDC immune class 2 (moderate immunodeficiency) and 6 (43%) were class 3 (severe immunodeficiency). After commencing ART the mean difference in admissions was--1.5+/-2.55 admissions (95% CI -2.3, -0.6; p < 0.001) and in length of stay was -12.9+/-21 day (95% CI -19.9, -0.5.9; p < 0.001). Antiretroviral therapy resulted in a mean weight gain of 2.8 kg+/-4.9 kg (95% CI 1.0, 4.5; p < 0.003) and a mean gain in height of 1.7 cm+/-2.6 cm (95% CI 0.6, 2.8; p < 0.003). Five children required second line therapy.
The introduction of antiretroviral therapy has resulted in improved outcomes and is being initiated in older children cared for mainly at home. Limitations in accessing affordable second line agents underscore the need for compliance with first line therapy.
本研究描述了一组接受抗逆转录病毒治疗（ART）的牙买加HIV感染儿童，并报告了结果。
对接受抗逆转录病毒药物治疗（ART）的牙买加HIV感染儿童进行了一项观察性前瞻性研究。在开始ART时及开始ART后的六个月内，比较了体重、身高、住院次数和住院时间等结果指标。
2001年至2003年期间，110名接受ART的HIV感染儿童中有37名（33.6%）。开始治疗时的中位年龄为6岁（年龄范围1 - 16岁），其中54.1%（20名）为男性，48%为艾滋病孤儿。68%的病例在家接受治疗，西印度大学医院管理27例（73%），布斯塔曼特儿童医院管理10例（27%）。根据疾病控制与预防中心（CDC）临床分类，C类（严重症状）22例（59.5%）；B类（中度症状）8例（21.6%）；A类（轻度症状）6例（16.2%）；N类（无症状）1例（2.7%）。在14名（36%）有CD4计数的儿童中，8名（57%）为CDC免疫2类（中度免疫缺陷），6名（43%）为3类（严重免疫缺陷）。开始ART后，住院次数的平均差异为–1.5±2.55次住院（95%可信区间–2.3，–0.6；p<0.001），住院时间的平均差异为–12.9±21天（95%可信区间–19.9，–5.9；p<0.001）。抗逆转录病毒治疗使平均体重增加2.8 kg±4.9 kg（95%可信区间1.0，4.5；p<0.003），平均身高增加1.7 cm±2.6 cm（95%可信区间0.6，2.8；p<0.003）。5名儿童需要二线治疗。
抗逆转录病毒治疗的引入改善了治疗效果，并且主要在家中接受照料的大龄儿童也开始接受该治疗。获取负担得起的二线药物存在限制，这突出了遵守一线治疗的必要性。
