Ylitalo Nathalie, Brogly Susan, Hughes Michael D, Nachman Sharon, Dankner Wayne, Van Dyke Russell, Seage George R
Department of Epidemiology and Biostatistics and Center for Biostatistics in AIDS Research, Harvard School of Public Health, Boston, Mass 02155, USA.
Arch Pediatr Adolesc Med. 2006 Aug;160(8):778-87. doi: 10.1001/archpedi.160.8.778.
To examine the relationship between the use of highly active antiretroviral treatment (HAART) and the occurrence of opportunistic illnesses (OIs) among children perinatally infected with human immunodeficiency virus.
Prospective cohort study.
Pediatric AIDS Clinical Trials Group 219C cohort.
From September 15, 2000, to August 31, 2003, 1927 children perinatally infected with human immunodeficiency virus and receiving HAART were followed up. Main Exposures Age at initiating HAART, duration of HAART use, CD4+ T-lymphocyte percentage, and human immunodeficiency virus 1 viral load.
Incidence rates for Centers for Disease Control and Prevention OI category B and OI category C events were calculated. The association between main exposures and OI occurrence was estimated using proportional hazards regression.
Of 1927 subjects, 226 (12.7%) developed OIs during follow-up. Incidence rates were 4.99 per 100 person-years (95% confidence interval, 4.30-5.76) for first OI category B events and 1.47 per 100 person-years (95% confidence interval, 1.12-1.91) for first OI category C events. Duration of HAART use was not related to OI risk. Older age (age >10 years) at HAART initiation was associated with increased risk of a first OI (hazard ratio, 2.48; 95% confidence interval, 1.23-5.00) compared with initiating HAART in children younger than 2 years. This increased risk diminished after adjusting for CD4+ T-lymphocyte percentage and Centers for Disease Control and Prevention disease category at HAART initiation. More children with OIs than without OIs had a CD4+ T-lymphocyte percentage of less than 15% at HAART initiation (49.6% of children with OIs vs 23.7% of children without OIs), at enrollment (41.2% of children with OIs vs 7.7% of children without OIs), and at the end of follow-up (41.2% of children with OIs vs 8.3% of children without OIs).
Opportunistic illnesses are occurring in the pediatric human immunodeficiency virus population in the HAART era, mainly in children with persistently low CD4+ T-lymphocyte percentages. Lack of a sustained response to HAART rather than age at or duration of HAART use is predictive of OI risk.
研究高效抗逆转录病毒治疗（HAART）的使用与围产期感染人类免疫缺陷病毒的儿童发生机会性感染（OIs）之间的关系。
前瞻性队列研究。
儿科艾滋病临床试验组219C队列。
从2000年9月15日至2003年8月31日，对1927名围产期感染人类免疫缺陷病毒并接受HAART治疗的儿童进行随访。主要暴露因素包括开始HAART治疗时的年龄、HAART治疗的持续时间、CD4 + T淋巴细胞百分比以及人类免疫缺陷病毒1病毒载量。
计算疾病控制与预防中心B类和C类机会性感染事件的发病率。使用比例风险回归估计主要暴露因素与机会性感染发生之间的关联。
在1927名受试者中，226名（12.7%）在随访期间发生了机会性感染。首次B类机会性感染事件的发病率为每100人年4.99例（95%置信区间，4.30 - 5.76），首次C类机会性感染事件的发病率为每100人年1.47例（95%置信区间，1.12 - 1.91）。HAART治疗的持续时间与机会性感染风险无关。与2岁以下儿童开始接受HAART治疗相比，开始HAART治疗时年龄较大（年龄>10岁）与首次发生机会性感染的风险增加相关（风险比，2.48；95%置信区间，1.23 - 5.00）。在调整了开始HAART治疗时的CD4 + T淋巴细胞百分比和疾病控制与预防中心疾病类别后，这种增加的风险降低了。与未发生机会性感染的儿童相比，更多发生机会性感染的儿童在开始HAART治疗时（发生机会性感染的儿童中有49.6% vs未发生机会性感染的儿童中有23.7%）、入组时（发生机会性感染的儿童中有41.2% vs未发生机会性感染的儿童中有7.7%）以及随访结束时（发生机会性感染的儿童中有41.2% vs未发生机会性感染的儿童中有8.3%）CD4 + T淋巴细胞百分比低于15%。
在HAART时代，儿科人类免疫缺陷病毒感染人群中发生机会性感染，主要发生在CD4 + T淋巴细胞百分比持续较低的儿童中。对HAART缺乏持续反应而非开始HAART治疗的年龄或治疗持续时间可预测机会性感染风险。
