Resino Salvador, Resino Rosa, Maria Bellón José, Micheloud Dariela, Gutiérrez Maria Dolores Gurbindo, de José Maria Isabel, Ramos José Tomás, Fontelos Pablo Martín, Ciria Luis, Muñoz-Fernández Maria Angeles
Laboratorio de Inmuno-Biología Molecular, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
Clin Infect Dis. 2006 Jul 15;43(2):243-52. doi: 10.1086/505213. Epub 2006 Jun 9.
Background. Use of antiretroviral therapy has resulted in a decrease in morbidity and mortality rates in human immunodeficiency virus type 1 (HIV-1)-infected children.Methods. We performed a retrospective study involving 427 children to determine the effectiveness of different antiretroviral therapy protocols on clinical outcome. The follow-up period was divided into 5 calendar periods (CPs): CP1 (1980-1989), before antiretroviral therapy was administered; CP2 (1990-1993), when monotherapy was administered; CP3 (1994-1996), when combined therapy was administered; CP4 (1997-1998), when </=50% of children were receiving highly active antiretroviral therapy (HAART); and CP5 (1999-2003), when >/=60% of children were receiving HAART.Results. Children experienced a progressive increase in the CD4(+) cell count and decrease in the viral load from 1997 onwards. A lower number of AIDS cases and deaths occurred during CP5 than during the other CPs (P<.01), with a relative risk of an absence of AIDS of >20 and a relative risk of survival of >30. The AIDS rate was >50% in CP1; we observed a very strong decrease to 14% in CP2, to 16% in CP3, to 7% in CP4, and to 2% in CP5. The mortality rates in CP2 and CP3 were >6% and thereafter decreased to 0.5% in CP5. The relative risks for no hospital admission in CP4 and CP5 were >3.5. The total rates of hospital admission in CP1, CP2, and CP3 were >30%; we observed a decrease in CP4 and CP5. The duration of hospitalization decreased during the follow-up period, and it was higher in CP1 (~30 days) than in the other periods.Conclusions. We observed that HAART produces a decrease in adverse clinical outcomes (i.e., hospital admission, AIDS, and death) in children with vertical HIV-1 infection in Madrid, Spain.
背景。抗逆转录病毒疗法的使用已使1型人类免疫缺陷病毒（HIV-1）感染儿童的发病率和死亡率有所下降。
方法。我们进行了一项涉及427名儿童的回顾性研究，以确定不同抗逆转录病毒治疗方案对临床结局的有效性。随访期分为5个日历时间段（CPs）：CP1（1980 - 1989年），在开始抗逆转录病毒治疗之前；CP2（1990 - 1993年），进行单一疗法时；CP3（1994 - 1996年），进行联合疗法时；CP4（1997 - 1998年），当时≤50%的儿童接受高效抗逆转录病毒治疗（HAART）；以及CP5（1999 - 2003年），当时≥60%的儿童接受HAART。
结果。自1997年起，儿童的CD4(+)细胞计数逐渐增加，病毒载量逐渐下降。与其他CPs相比，CP5期间发生的艾滋病病例和死亡数量更少（P<0.01），无艾滋病的相对风险>20，生存的相对风险>30。CP1中的艾滋病发生率>50%；我们观察到在CP2中大幅降至14%，在CP3中降至16%，在CP4中降至7%，在CP5中降至2%。CP2和CP3中的死亡率>6%，此后在CP5中降至0.5%。CP4和CP5中未住院的相对风险>3.5。CPⅠ、CP2和CP3中的总住院率>30%；我们观察到在CP4和CP5中有所下降。随访期间住院时间缩短，CP1期间住院时间较长（约30天），高于其他时间段。
结论。我们观察到，在西班牙马德里，HAART可降低垂直感染HIV-1儿童的不良临床结局（即住院、艾滋病和死亡）。
