Nesheim Steven R, Kapogiannis Bill G, Soe Minn M, Sullivan Kevin M, Abrams Elaine, Farley John, Palumbo Paul, Koenig Linda J, Bulterys Marc
Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA.
Pediatrics. 2007 Jul;120(1):100-9. doi: 10.1542/peds.2006-2052.
We sought to determine the impact of highly active antiretroviral therapy on the incidence and prevalence of opportunistic infections in HIV-infected children.
Children born from 1986 to 1998 were monitored until 2004 in the Perinatal AIDS Collaborative Transmission Study, sponsored by the Centers for Disease Control and Prevention. We determined the pre-highly active antiretroviral therapy and post-highly active antiretroviral therapy (before and after January 1, 1997, respectively) incidence rates of opportunistic infections among HIV-infected children and characterized the temporal decreases in percentages of CD4+ cells and the mortality rates among patients with and those without incident opportunistic infections.
The overall opportunistic infection incidence declined from 14.4 to 1.1 cases per 100 patient-years; statistically significant reductions were seen in the incidence of the most common opportunistic infections, including Pneumocystis jiroveci pneumonia (5.8 vs 0.3 cases per 100 patient-years), recurrent bacterial infections (4.7 vs 0.2 cases per 100 patient-years), extraocular cytomegalovirus infection (1.4 vs 0.1 cases per 100 patient-years), and disseminated nontuberculous mycobacterial infection (1.3 vs 0.2 cases per 100 patient-years). Kaplan-Meier analysis of time from birth to the first opportunistic infection illustrated more-rapid acquisition of opportunistic infections by HIV-infected children born in the pre-highly active antiretroviral therapy era than by those born later. In the first 3 years of life, there was a faster decline in the percentage of CD4+ cells among children with opportunistic infections. The mortality rate was significantly higher among children with opportunistic infections.
Reduction in the incidence of opportunistic infections and prolongation of the time to the first opportunistic infection were noted during the post-highly active antiretroviral therapy era. Children who experienced opportunistic infections had higher mortality rates than did those who did not. Younger children (<3 years) who experienced opportunistic infections had faster declines in percentages of CD4+ T cells.
我们试图确定高效抗逆转录病毒疗法对感染HIV儿童机会性感染发病率和患病率的影响。
在疾病控制与预防中心发起的围产期艾滋病协作传播研究中，对1986年至1998年出生的儿童进行监测直至2004年。我们确定了感染HIV儿童在高效抗逆转录病毒疗法前和高效抗逆转录病毒疗法后（分别在1997年1月1日之前和之后）机会性感染的发病率，并描述了CD4+细胞百分比的时间性下降以及有和没有新发机会性感染患者的死亡率。
总体机会性感染发病率从每100患者年14.4例降至1.1例；最常见的机会性感染发病率有统计学意义的下降，包括耶氏肺孢子菌肺炎（每100患者年5.8例对0.3例）、复发性细菌感染（每100患者年4.7例对0.2例）、眼外巨细胞病毒感染（每100患者年1.4例对0.1例）和播散性非结核分枝杆菌感染（每100患者年1.3例对0.2例）。对从出生到首次机会性感染时间的Kaplan-Meier分析表明，在高效抗逆转录病毒疗法时代之前出生的感染HIV儿童比之后出生的儿童更快获得机会性感染。在生命的前3年，有机会性感染儿童的CD4+细胞百分比下降更快。有机会性感染儿童的死亡率显著更高。
在高效抗逆转录病毒疗法时代之后，机会性感染发病率降低，首次机会性感染时间延长。经历机会性感染的儿童比未经历者有更高的死亡率。经历机会性感染的年幼儿童（<3岁）CD4+T细胞百分比下降更快。
