Newell Marie-Louise, Patel Deven, Goetghebuer Tessa, Thorne Claire
Centre for Paediatric Epidemiology and Biostatistics, Institute of Child Health, University College London, United Kingdom.
J Infect Dis. 2006 Apr 1;193(7):954-62. doi: 10.1086/500842. Epub 2006 Feb 23.
Considerable uncertainty remains as to whether early initiation of antiretroviral therapy (ART) in children with vertically acquired human immunodeficiency virus (HIV) infection increases the benefit in terms of immunological response.
The association between immunological outcome and early initiation of and/or more-potent ART was investigated, using age-standardized z scores for CD4 cell counts (hereafter, "CD4 z scores"), in 131 HIV-infected children enrolled in the European Collaborative Study, a birth cohort study.
Median age at initiation of the most-potent ART was 4 years (range, 0.1-15.5 years). Initiation of treatment after 5 months of age resulted in nonsignificantly lower CD4 z scores 6 months after initiation. Time to a 20% increase in CD4 z score was associated with age at initiation of the most-potent ART (adjusted hazard ratios [AHRs], 0.37 [P<.01] and 0.43 [P = .05] for 5 months-5 years of age and >5 years of age, respectively, compared with <5 months of age), ethnicity (AHR, 0.48 [P = .01], for black vs. white), and highly active ART (HAART) with or without prior ART (AHRs, 3.16 [P<.01] and 3.95 [P<.001], vs. mono or dual ART, respectively). The risk of subsequent deterioration of CD4 z score was similar for children who initiated ART in different age groups ( chi2 = 0.824; P = .82).
We confirm the effectiveness of HAART with respect to the recovery of CD4 cell count and suggest a benefit of initiating ART before the age of 5 months. Age at initiation of the most-potent ART was not associated with the likelihood of sustaining the recovery of CD4 cell count.
对于垂直感染人类免疫缺陷病毒（HIV）的儿童早期开始抗逆转录病毒治疗（ART）是否能在免疫反应方面增加获益仍存在相当大的不确定性。
在一项出生队列研究——欧洲协作研究中，对131名感染HIV的儿童进行了研究，使用年龄标准化的CD4细胞计数z评分（以下简称“CD4 z评分”）来调查免疫结果与早期开始和/或更强效ART之间的关联。
开始使用最强效ART的中位年龄为4岁（范围为0.1 - 15.5岁）。5个月龄后开始治疗在开始治疗6个月后导致CD4 z评分略低，但无统计学意义。CD4 z评分增加20%的时间与开始使用最强效ART的年龄相关（与<5个月龄相比，5个月至5岁和>5岁开始治疗的调整风险比[AHRs]分别为0.37[P<.01]和0.43[P = .05]）、种族（黑人与白人相比，AHR为0.48[P = .01]）以及使用或未使用过ART的高效抗逆转录病毒治疗（HAART）（分别与单一或双重ART相比，AHRs为3.16[P<.01]和3.95[P<.001]）。不同年龄组开始ART的儿童随后CD4 z评分恶化的风险相似（χ2 = 0.824；P = .82）。
我们证实了HAART在恢复CD4细胞计数方面的有效性，并表明在5个月龄前开始ART有益。开始使用最强效ART的年龄与维持CD4细胞计数恢复的可能性无关。
