Kourtis Athena P, Bansil Pooja, Posner Samuel F, Johnson Christopher, Jamieson Denise J
Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia 30341, USA.
Pediatrics. 2007 Aug;120(2):e236-43. doi: 10.1542/peds.2006-3268. Epub 2007 Jul 2.
The objective of this study was to describe trends in hospital use by HIV-infected children and adolescents in the United States in the 10 years from 1994 (before highly active antiretroviral therapy) to 2003 (widespread use of highly active antiretroviral therapy).
Data from the Nationwide Inpatient Sample database were used. The most frequent diagnoses were evaluated by year, and trends in hospitalizations for selected diagnoses and procedures were examined by multivariate logistic regression.
In 2003, there were an estimated 3419 hospitalizations of HIV-infected children who were 18 years or younger, compared with 11785 such hospitalizations in 1994 (a 71% decrease). This decrease was more marked among infants and children who were younger than 5 years (94% for boys and 92% for girls) than among adolescents (decrease of 47% for boys and increase of 23% for girls 15-18 years of age). The inpatient fatality rate among HIV-infected children decreased from 5.0% in 1994 to 1.8% in 2003. The number of hospitalizations among HIV-infected children in the highly active antiretroviral therapy era decreased significantly compared with before highly active antiretroviral therapy (1994-1996) for Pneumocystis jiroveci, bacterial infection, or sepsis; fungal infection; encephalopathy; failure to thrive; and lymphocytic interstitial pneumonia. No significant change in the number of hospitalizations for Pneumococcus or cytomegalovirus was observed.
Dramatic decreases in the number of hospitalizations among HIV-infected children occurred since the advent of highly active antiretroviral therapy in the United States. However, this trend is not seen in hospitalizations of adolescents, particularly girls. Hospitalizations for several HIV-related conditions are less frequent in the highly active antiretroviral therapy era, but for certain other conditions, the hospitalization burden remains high.
本研究的目的是描述1994年（高效抗逆转录病毒治疗之前）至2003年（高效抗逆转录病毒治疗广泛应用）这10年间美国感染HIV的儿童和青少年的住院情况趋势。
使用来自全国住院样本数据库的数据。按年份评估最常见的诊断，并通过多因素逻辑回归分析选定诊断和手术的住院趋势。
2003年，估计有3419名18岁及以下感染HIV的儿童住院，而1994年有11785名此类儿童住院（减少了71%）。这种减少在5岁以下的婴儿和儿童中比青少年中更为明显（男孩减少94%，女孩减少92%），而青少年中男孩减少47%，15 - 18岁女孩增加23%。感染HIV儿童的住院死亡率从1994年的5.0%降至2003年的1.8%。在高效抗逆转录病毒治疗时代，感染HIV儿童因耶氏肺孢子菌、细菌感染或败血症、真菌感染、脑病、发育不良和淋巴细胞间质性肺炎的住院人数与高效抗逆转录病毒治疗前（1994 - 1996年）相比显著减少。肺炎球菌或巨细胞病毒感染的住院人数未观察到显著变化。
自美国出现高效抗逆转录病毒治疗以来，感染HIV儿童的住院人数大幅下降。然而，青少年尤其是女孩的住院情况未出现这种趋势。在高效抗逆转录病毒治疗时代，几种与HIV相关疾病的住院频率较低，但对于某些其他疾病，住院负担仍然很高。
