Eley Brian, Davies Mary-Ann, Apolles Patti, Cowburn Carol, Buys Heloise, Zampoli Marco, Finlayson Heather, King Spasina, Nuttall James
Red Cross War Memorial Children's Hospital, Rondebosch, Cape Town, South Africa.
S Afr Med J. 2006 Sep;96(9 Pt 2):988-93.
To describe the response of children during their first year on highly active antiretroviral therapy (HAART).
Retrospective, descriptive.
Tertiary, referral hospital.
All HIV-infected children commenced on HAART from 1 August 2002 until 31 December 2004.
Children were retrospectively restaged using the WHO 4-stage clinical classification and CDC immunological staging system. After commencing HAART, patients were assessed at monthly intervals for the first 6 months and thereafter mostly 3-monthly. Baseline and 6- monthly CD4 counts and viral loads were performed.
Of 409 children commenced on HAART, 50.6% were < 2 years old, 62.7% had severe clinical disease and 76.6% had severe immune suppression. After 1 year, 65.8% were alive and continued HAART at the hospital, 11.2% had been transferred to another antiretroviral site, 15.4% had died, 4.6% were lost to follow-up and treatment had been discontinued in 2.9%. Kaplan-Meier survival estimate for 407 children at 1 year was 84% (95% confidence interval (CI) 80 - 87%). On multivariate analysis, survival was adversely affected in children with WHO stage 4 v. stage 2 and 3 disease (adjusted hazard ratio (HR): 5.26 (95% CI 2.25 - 12.32), p = 0.000), age < 12 months (adjusted HR: 2.46 (95% CI 1.48 - 4.09), p = 0.001) and CD4 absolute count (per 100 cell increase) (adjusted HR: 0.93 (95% CI 0.88 - 0.98), p = 0.013). In a separate multivariate model including only children with an initial viral load (N = 367), viral load > or = 1 million copies/ml (adjusted HR: 1.84 (95% CI 1.03 - 3.29)) and taking a protease inhibitor (PI)-based regimen (adjusted HR: 2.25 (95% CI 1.10 - 4.61)) were additionally independently associated with poorer survival; however, young age was not a significant predictor of mortality, after adjusting for viral load (p = 0.119). After 1 year of HAART 184/264 (69.7%) of children had a viral load < 400 copies/ml. Comparative analysis showed significant improvements in growth, immunological status and virological control.
HAART can improve the health of many HIV-infected children with advanced disease, including those aged less than 2 years in resource-limited settings.
描述儿童在接受高效抗逆转录病毒治疗（HAART）的第一年中的反应。
回顾性、描述性研究。
三级转诊医院。
2002年8月1日至2004年12月31日开始接受HAART治疗的所有HIV感染儿童。
采用世界卫生组织（WHO）4期临床分类和美国疾病控制与预防中心（CDC）免疫分期系统对儿童进行回顾性重新分期。开始HAART治疗后，患者在最初6个月每月进行评估，此后大多每3个月评估一次。进行基线和每6个月的CD4细胞计数及病毒载量检测。
在409例开始接受HAART治疗的儿童中，50.6%年龄小于2岁，62.7%患有严重临床疾病，76.6%有严重免疫抑制。1年后，65.8%存活并继续在医院接受HAART治疗，11.2%已转至另一个抗逆转录病毒治疗点，15.4%死亡，4.6%失访，2.9%停止治疗。407例儿童1年的Kaplan-Meier生存估计值为84%（95%置信区间（CI）80 - 87%）。多因素分析显示，与WHO 2期和3期疾病相比，WHO 4期疾病的儿童生存受到不利影响（调整后的风险比（HR）：5.26（95%CI 2.25 - 12.32），p = 0.000），年龄小于12个月（调整后的HR：2.46（95%CI 1.48 - 4.09），p = 0.001）以及CD4绝对计数（每增加100个细胞）（调整后的HR：0.93（95%CI 0.88 - 0.98），p = 0.013）。在一个仅包括初始有病毒载量的儿童的单独多因素模型中（N = 367），病毒载量≥100万拷贝/ml（调整后的HR：1.84（95%CI 1.03 - 3.29））以及采用基于蛋白酶抑制剂（PI）的治疗方案（调整后的HR：2.25（95%CI 1.10 - 4.61））也与较差的生存独立相关；然而，在调整病毒载量后，年轻不是死亡率的显著预测因素（p = 0.119）。HAART治疗1年后，184/264（69.7%）的儿童病毒载量<400拷贝/ml。比较分析显示在生长、免疫状态和病毒学控制方面有显著改善。
HAART可改善许多患有晚期疾病的HIV感染儿童的健康状况，包括资源有限环境中年龄小于2岁的儿童。
