Nyandiko Winstone M, Ayaya Samuel, Nabakwe Esther, Tenge Constance, Sidle John E, Yiannoutsos Constantin T, Musick Beverly, Wools-Kaloustian Kara, Tierney William M
Department of Child Health and Pediatrics, Moi University School of Medicine, PO Box 2582-30100, Eldoret, Kenya.
J Acquir Immune Defic Syndr. 2006 Dec 1;43(4):418-25. doi: 10.1097/01.qai.0000243122.52282.89.
Determine outcome differences between orphaned and non-orphaned children receiving antiretroviral therapy (ART).
Retrospective review of prospectively recorded electronic data.
Nine HIV clinics in western Kenya.
279 children on ART enrolled between August 2002 and February 2005.
Orphan status, CD4%, sex- and age-adjusted height (HAZ) and weight (WAZ) z scores, ART adherence, mortality.
Median follow-up was 34 months. Cohort included 51% males and 54% orphans. At ART initiation (baseline), 71% of children had CDC clinical stage B or C disease. Median CD4% was 9% and increased dramatically the first 30 weeks of therapy, then leveled off. Parents and guardians reported perfect adherence at every visit for 75% of children. Adherence and orphan status were not significantly associated with CD4% response. Adjusted for baseline age, follow-up was significantly shorter among orphaned children (median 33 vs. 41 weeks, P = 0.096). One-year mortality was 7.1% for orphaned and 6.6% for non-orphaned children (P = 0.836). HAZ and WAZ were significantly below norm in both groups. With ART, HAZ remained stable, while WAZ tended to increase toward the norm, especially among non-orphans. Orphans showed identical weight gains as non-orphans the first 70 weeks after start of ART but experienced reductions afterwards.
Good ART adherence is possible in western rural Kenya. ART for HIV-infected children produced substantial and sustainable CD4% improvement. Orphan status was not associated with worse short-term outcomes but may be a factor for long-term therapy response. ART alone may not be sufficient to reverse significant developmental lags in the HIV-positive pediatric population.
确定接受抗逆转录病毒疗法（ART）的孤儿与非孤儿儿童之间的结局差异。
对前瞻性记录的电子数据进行回顾性分析。
肯尼亚西部的9家艾滋病毒诊所。
2002年8月至2005年2月期间登记接受ART治疗的279名儿童。
孤儿身份、CD4%、按性别和年龄调整的身高（HAZ）和体重（WAZ）z评分、ART依从性、死亡率。
中位随访时间为34个月。队列中51%为男性，54%为孤儿。开始接受ART治疗（基线时），71%的儿童患有美国疾病控制与预防中心（CDC）临床B期或C期疾病。中位CD4%为9%，在治疗的前30周显著增加，然后趋于平稳。父母和监护人报告称，75%的儿童每次就诊时依从性良好。依从性与孤儿身份和CD4%反应无显著关联。校正基线年龄后，孤儿儿童的随访时间显著较短（中位时间分别为33周和41周，P = 0.096）。孤儿儿童的1年死亡率为7.1%，非孤儿儿童为6.6%（P = 0.836）。两组儿童的HAZ和WAZ均显著低于正常水平。接受ART治疗后，HAZ保持稳定，而WAZ趋于向正常水平增加，尤其是在非孤儿儿童中。孤儿在开始接受ART治疗后的前70周体重增加情况与非孤儿相同，但之后体重下降。
在肯尼亚西部农村地区，良好的ART依从性是可能的。针对感染艾滋病毒儿童的ART治疗使CD4%得到了显著且可持续的改善。孤儿身份与短期结局较差无关，但可能是长期治疗反应的一个因素。仅靠ART可能不足以扭转艾滋病毒阳性儿童群体中显著的发育滞后情况。
