Kordy Faisal, Al-Hajjar Sami, Frayha Husn H, Al-Khlaif Riyadh, Al-Shahrani Dayel, Akthar Javed
Maternity and Children Hospital, Medina, Saudi Arabia.
Ann Saudi Med. 2006 Mar-Apr;26(2):92-9. doi: 10.5144/0256-4947.2006.92.
Vertical transmission from mother to infant is the most common mode of transmission of HIV infection in children. Data on pediatric HIV in the Middle East and Gulf region are scarce. We describe the spectrum, characteristics and outcome of HIV infection in Saudi children.
We collected descriptive data on HIV-infected or exposed children seen at the King Faisal Hospital and Research Centre (KFSH&RC) between 1986 and 2003.
Sixty-three children had proven HIV infection. The source of infection was perinatal transmission in 63.5% of cases and contaminated blood or blood products transfusion in 34.5%. Median age at diagnosis was 6 years. In 42 patients for whom complete records were available, 90% were delivered by spontaneous vaginal delivery and 10% by cesarean delivery. Ninety-three percent of infected infants were breastfed throughout infancy. The complete medical records were available for 66% of children; for the remainder, part of the records could not be retrieved. Thirteen percent had an AIDS-defining opportunistic infection, with disseminated cytomegalovirus (CMV) infection being the most common (37.5%). All cases received antiretroviral therapy starting in 1997. Of those who received highly active antiretroviral therapy, 79% were compliant with treatment and had a sustained virologic response below the detectable level. Seventy-five percent of those diagnosed before 1995 died compared with 7.7% diagnosed later.
Effective preventive measures, such as antiretroviral prophylaxis, cesarean delivery, and abstention from breastfeeding are not being applied. This could be largely due to lack of knowledge among patients and healthcare providers. Physicians must recognize the signs and symptoms of HIV infection, and have a high index of suspicion so that infected children are diagnosed early and referred to a specialized center for treatment and follow-up.
母婴垂直传播是儿童感染艾滋病毒最常见的传播方式。中东和海湾地区关于儿童艾滋病毒的数据稀缺。我们描述了沙特儿童艾滋病毒感染的范围、特征和结果。
我们收集了1986年至2003年期间在费萨尔国王医院和研究中心（KFSH&RC）就诊的艾滋病毒感染或暴露儿童的描述性数据。
63名儿童被证实感染艾滋病毒。感染源在63.5%的病例中是围产期传播，在34.5%的病例中是受污染的血液或血液制品输血。诊断时的中位年龄为6岁。在有完整记录的42名患者中，90%通过自然阴道分娩，10%通过剖宫产分娩。93%的感染婴儿在整个婴儿期都进行母乳喂养。66%的儿童有完整的医疗记录；其余部分，部分记录无法找回。13%的儿童患有艾滋病定义的机会性感染，播散性巨细胞病毒（CMV）感染最为常见（37.5%）。所有病例从1997年开始接受抗逆转录病毒治疗。在接受高效抗逆转录病毒治疗的患者中，79%依从治疗，病毒学反应持续低于可检测水平。1995年前诊断出的患者中有75%死亡，而后来诊断出的患者中有7.7%死亡。
有效的预防措施，如抗逆转录病毒预防、剖宫产和避免母乳喂养并未得到应用。这在很大程度上可能是由于患者和医疗服务提供者缺乏相关知识。医生必须认识到艾滋病毒感染的体征和症状，并保持高度怀疑指数，以便早期诊断感染儿童并将其转诊至专门中心进行治疗和随访。
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