Rabie Helena, de Boer Anna, van den Bos Suzanne, Cotton Mark F, Kling Sharon, Goussard Pierre
Department of Paediatrics and Child Health Tygerberg Children's Hospital & Stellenbosch University, South Africa.
J Trop Pediatr. 2007 Aug;53(4):270-3. doi: 10.1093/tropej/fmm036. Epub 2007 May 25.
Early data regarding the outcome of human immunodeficiency virus (HIV)-infected children in paediatric intensive care units (PICU) suggested mortality as high as 100%. Recent studies report mortality of 38%. Survival depends on the indication for admission.
To describe the prevalence, duration of stay, and outcome of HIV-infected patients in a single PICU over a 1-year period. Additional objectives included describing the indications for admission as well as the clinical and laboratory characteristics of HIV-infected infants and children requiring PICU admission.
Retrospective chart review of all children with serological proof of HIV admitted to PICU at Tygerberg Children's Hospital from 1 January to 31 December 2003.
Of the 465 patients admitted, 47 (10%) were HIV-infected. For HIV-infected children the median age on admission was 4 months. The median duration of stay was 6 days, significantly longer than for the non-HIV group (p = 0.0001). Fifty-seven percent had advanced clinical and immunological disease. Seventeen died in PICU and four shortly afterwards, poor PICU outcome was significantly associated with HIV status (p = 0.001). Lower total lymphocyte count (p = 0.004) and higher gamma globulin level (p = 0.04) were paradoxically the only findings significantly associated with survival. Acute respiratory failure (ARF) accounted for 76% of admissions, including Pneumocystis jiroveci in 38%. Fifty-one percent had evidence of cytomegalovirus infection.
HIV-infected children requiring PICU can survive despite the lack of availability of antiretroviral therapy.
早期关于儿科重症监护病房（PICU）中感染人类免疫缺陷病毒（HIV）儿童的预后数据显示死亡率高达100%。近期研究报告的死亡率为38%。生存情况取决于入院指征。
描述在1年期间单个PICU中HIV感染患者的患病率、住院时间和预后。其他目的包括描述入院指征以及需要入住PICU的HIV感染婴幼儿的临床和实验室特征。
对2003年1月1日至12月31日期间入住泰格堡儿童医院PICU且有HIV血清学证据的所有儿童进行回顾性病历审查。
在465名入院患者中，47名（10%）感染了HIV。HIV感染儿童入院时的中位年龄为4个月。中位住院时间为6天，显著长于非HIV组（p = 0.0001）。57%的患者患有晚期临床和免疫疾病。17人在PICU死亡，4人随后不久死亡，PICU预后不良与HIV感染状态显著相关（p = 0.001）。矛盾的是，总淋巴细胞计数较低（p = 0.004）和γ球蛋白水平较高（p = 0.04）是与生存显著相关的唯一发现。急性呼吸衰竭（ARF）占入院原因的76%，其中38%为耶氏肺孢子菌感染。51%的患者有巨细胞病毒感染的证据。
尽管无法获得抗逆转录病毒治疗，但需要入住PICU的HIV感染儿童仍可存活。
