Kovacs A, Frederick T, Church J, Eller A, Oxtoby M, Mascola L
Department of Pathology, Los Angeles County/University of Southern California Medical Center 90033.
JAMA. 1991 Apr 3;265(13):1698-703.
The relationship between CD4 T-lymphocyte counts and infection with the human immunodeficiency virus (HIV) is retrospectively investigated for 266 HIV-infected and uninfected children who were born to infected women, including 39 with Pneumocystis carinii pneumonia (PCP), in a population-based surveillance study. Of 21 perinatally HIV-infected children with PCP only 10 (48%) had CD4 T-lymphocyte counts that were less than 500 x 10(6) cells/L (500 cells/mm3), compared with all 18 who were infected via blood transfusions or clotting factors. Among 68 children who were 1 year or younger, 18 (90%) of 20 PCP cases had CD4 T-lymphocyte counts that were less than 1500 x 10(6) cells/L (1500 cells/mm3) compared with only five (10%) of 48 children who did not have the acquired immunodeficiency syndrome (odds ratio, 77.4; 95% confidence interval, 19.7 to 313.4). The mean CD4 T-lymphocyte count was lower for the 39 PCP cases when compared with the 188 children who were at different stages of HIV infection and did not have the acquired immunodeficiency syndrome (AIDS) independent of age. The majority of perinatally HIV-infected children with PCP were 6 months or younger and 50% were previously unknown to be infected. Thus, HIV-positive children should be identified early and followed closely. CD4 T-lymphocyte counts may be useful in monitoring HIV-positive children and determining when to begin PCP prophylaxis.
在一项基于人群的监测研究中，对266名感染艾滋病病毒（HIV）的孕妇所生的感染和未感染HIV的儿童进行了回顾性调查，其中包括39例患有卡氏肺孢子虫肺炎（PCP）的儿童。在21例围产期感染HIV且患有PCP的儿童中，只有10例（48%）的CD4 T淋巴细胞计数低于500×10⁶细胞/L（500个细胞/mm³），而所有18例通过输血或凝血因子感染的儿童均低于该数值。在68名1岁及以下的儿童中，20例PCP病例中有18例（90%）的CD4 T淋巴细胞计数低于1500×10⁶细胞/L（1500个细胞/mm³），相比之下，48例未患获得性免疫缺陷综合征的儿童中只有5例（10%）低于该数值（优势比为77.4；95%置信区间为19.7至313.4）。与188名处于HIV感染不同阶段且未患获得性免疫缺陷综合征（AIDS）的儿童相比，39例PCP病例的平均CD4 T淋巴细胞计数更低，且与年龄无关。大多数围产期感染HIV且患有PCP的儿童年龄在6个月及以下，50%此前未知已感染。因此，应尽早识别HIV阳性儿童并密切随访。CD4 T淋巴细胞计数可能有助于监测HIV阳性儿童并确定何时开始PCP预防。
