Jeena Prakash, Thea Donald M, MacLeod William B, Chisaka Noel, Fox Matthew P, Coovadia H M, Qazi Shamim
Department of Paediatrics and Child Health, King Edward Hospital, University of KwaZulu Natal, Durban, South Africa.
Bull World Health Organ. 2006 Apr;84(4):269-75. doi: 10.2471/blt.04.015222. Epub 2006 Apr 13.
To determine whether children aged 3-59 months with mild or non-symptomatic human immunodeficiency virus (HIV) infection and WHO-defined severe pneumonia have a higher failure rate than do HIV-uninfected children when treated with the standard WHO treatment of parenteral penicillin or oral amoxicillin.
This study was a planned sub-analysis of a randomized trial of 3-59-month-old children presenting with WHO-defined severe pneumonia (the APPIS study). We included two sites with high HIV prevalence in Durban, South Africa and Ndola, Zambia. Primary outcome measures were clinical treatment failure at day 2 and day 14. CLINICALTRIALS.GOV IDENTIFIER: CT00227331http://www.clinicaltrialsgov/show/NCT00227331).
Of the 523 children enrolled, HIV status was known for 464 participants; 106 (23%) of these were infected with HIV. By day 2, 57 (12.3%) children had failed treatment and 110 (23.7%) failed by day 14. Twenty (18.9%) HIV-infected children failed by day 2 compared with 37 (10.3%) uninfected children (adjusted odds ratio (OR) 2.07; 95% confidence interval (CI): 1.07-4.00). Thirty-four (32.1%) HIV-infected children failed treatment by day 14 compared with 76 (21.2%) uninfected children (adjusted OR 1.88; 95% CI: 1.11-3.17). Analysis stratified by age showed that the greatest differential in treatment failure at day 2 and day 14 occurred in the children aged 3-5 months.
HIV-infected children with severe pneumonia fail WHO-standard treatment with parenteral penicillin or amoxicillin at day 2 and day 14 more often than do HIV-uninfected children, especially young infants. Standard case management of acute respiratory infection (ARI) using WHO treatment guidelines is inadequate in areas of high HIV prevalence and reappraisal of empiric antimicrobial therapy is urgently needed for severe pneumonia associated with HIV-1.
确定3至59个月大的轻度或无症状人类免疫缺陷病毒（HIV）感染且患有世界卫生组织（WHO）定义的重度肺炎的儿童，在接受WHO标准的胃肠外青霉素或口服阿莫西林治疗时，其治疗失败率是否高于未感染HIV的儿童。
本研究是对一项针对出现WHO定义的重度肺炎的3至59个月大儿童的随机试验（APPIS研究）进行的计划中的亚分析。我们纳入了南非德班和赞比亚恩多拉两个HIV高流行率地区。主要结局指标为第2天和第14天的临床治疗失败情况。临床试验注册编号：CT00227331（http://www.clinicaltrialsgov/show/NCT00227331）。
在纳入的523名儿童中，464名参与者的HIV感染状况已知；其中106名（23%）感染了HIV。到第2天，57名（12.3%）儿童治疗失败，到第14天，110名（23.7%）儿童治疗失败。到第2天，20名（18.9%）感染HIV的儿童治疗失败，而未感染的儿童有37名（10.3%）（调整后的优势比（OR）为2.07；95%置信区间（CI）：1.07 - 4.00）。到第14天，34名（32.1%）感染HIV的儿童治疗失败，而未感染的儿童有76名（21.2%）（调整后的OR为1.88；95%CI：1.11 - 3.17）。按年龄分层分析显示，第2天和第14天治疗失败的最大差异出现在3至5个月大的儿童中。
患有重度肺炎的HIV感染儿童在第2天和第14天接受WHO标准的胃肠外青霉素或阿莫西林治疗时，比未感染HIV的儿童更常治疗失败，尤其是年幼婴儿。在HIV高流行地区，使用WHO治疗指南对急性呼吸道感染（ARI）进行标准病例管理是不够的，对于与HIV - 1相关的重度肺炎，迫切需要重新评估经验性抗菌治疗。
