Wamalwa Dalton C, Farquhar Carey, Obimbo Elizabeth M, Selig Sara, Mbori-Ngacha Dorothy A, Richardson Barbra A, Overbaugh Julie, Emery Sandy, Wariua Grace, Gichuhi Christine, Bosire Rose, John-Stewart Grace
Department of Pediatrics, University of Nairobi, Nairobi, Kenya.
J Acquir Immune Defic Syndr. 2007 Jul 1;45(3):311-7. doi: 10.1097/QAI.0b013e318042d613.
To describe the early response to World Health Organization (WHO)-recommended nonnucleoside reverse transcriptase inhibitor (NNRTI)-based first-line highly active antiretroviral therapy (HAART) in HIV-1-infected Kenyan children unexposed to nevirapine.
Observational prospective cohort.
HIV-1 RNA level, CD4 lymphocyte count, weight for age z score, and height for age z score were measured before the initiation of HAART and every 3 to 6 months thereafter. Children received no nutritional supplements.
Sixty-seven HIV-1-infected children were followed for a median of 9 months between August 2004 and November 2005. Forty-seven (70%) used zidovudine, lamivudine (3TC), and an NNRTI (nevirapine or efavirenz), whereas 25% used stavudine (d4T), 3TC, and an NNRTI. Nevirapine was used as the NNRTI by 46 (69%) children, and individual antiretroviral drug formulations were used by 63 (94%), with only 4 (6%) using a fixed-dose combination of d4T, 3TC, and nevirapine (Triomune; Cipla, Mumbai, India). In 52 children, the median height for age z score and weight for age z score rose from -2.54 to -2.17 (P<0.001) and from -2.30 to -1.67 (P=0.001), respectively, after 6 months of HAART. Hospitalization rates were significantly reduced after 6 months of HAART (17% vs. 58%; P<0.001). The median absolute CD4 count increased from 326 to 536 cells/microL (P<0.001), the median CD4 lymphocyte percentage rose from 5.8% before treatment to 15.4% (P<0.001), and the median viral load fell from 5.9 to 2.2 log10 copies/mL after 6 months of HAART (P<0.001). Among 43 infants, 47% and 67% achieved viral suppression to less than 100 copies/mL and 400 copies/mL, respectively, after 6 months of HAART.
Good early clinical and virologic response to NNRTI-based HAART was observed in HIV-1-infected Kenyan children with advanced HIV-1 disease.
描述未接触过奈韦拉平的HIV-1感染肯尼亚儿童对世界卫生组织（WHO）推荐的基于非核苷类逆转录酶抑制剂（NNRTI）的一线高效抗逆转录病毒疗法（HAART）的早期反应。
观察性前瞻性队列研究。
在开始HAART之前以及之后每3至6个月测量HIV-1 RNA水平、CD4淋巴细胞计数、年龄别体重Z评分和年龄别身高Z评分。儿童未接受营养补充剂。
2004年8月至2005年11月期间，对67名HIV-1感染儿童进行了中位时间为9个月的随访。47名（70%）儿童使用齐多夫定、拉米夫定（3TC）和一种NNRTI（奈韦拉平或依非韦伦），而25%的儿童使用司他夫定（d4T）、3TC和一种NNRTI。46名（69%）儿童使用奈韦拉平作为NNRTI，63名（94%）儿童使用了单独的抗逆转录病毒药物制剂，只有4名（6%）儿童使用了d4T、3TC和奈韦拉平的固定剂量组合（三联片；印度孟买西普拉公司）。在52名儿童中，HAART治疗6个月后，年龄别身高Z评分中位数从-2.54升至-2.17（P<0.001），年龄别体重Z评分中位数从-2.30升至-1.67（P=0.001）。HAART治疗6个月后住院率显著降低（17%对58%；P<0.001）。绝对CD4计数中位数从326个细胞/微升增至536个细胞/微升（P<0.001），CD4淋巴细胞百分比中位数从治疗前的5.8%升至15.4%（P<0.001），HAART治疗6个月后病毒载量中位数从5.9降至2.2 log10拷贝/毫升（P<0.001）。在43名婴儿中，HAART治疗6个月后，分别有47%和67%的婴儿病毒载量抑制至低于100拷贝/毫升和400拷贝/毫升。
在患有晚期HIV-1疾病的HIV-1感染肯尼亚儿童中，观察到对基于NNRTI的HAART有良好的早期临床和病毒学反应。
