Song Rinn, Jelagat Justine, Dzombo Doris, Mwalimu Marietta, Mandaliya Kishorchandra, Shikely Khadija, Essajee Shaffiq
Department of Pediatrics, New York University, New York, New York, USA.
Pediatrics. 2007 Oct;120(4):e856-61. doi: 10.1542/peds.2006-1122. Epub 2007 Sep 10.
Few studies have investigated the efficacy of antiretroviral therapy among HIV-infected children in resource-poor settings. This observational, retrospective analysis describes the clinical, immunologic, and virologic effects of highly active antiretroviral therapy in treatment-naive, HIV-infected children in Mombasa, Kenya. In keeping with a public health approach, all children were treated by using a simplified, nationally approved, triple-drug regimen.
Clinical data and stored plasma samples from 29 children who were followed prospectively between April 2003 and October 2004 were analyzed. All children received generic formulations of nevirapine, zidovudine, and lamivudine and were evaluated at baseline and at 3, 6, 9, 12, and 15 months. At each visit, weight and CD4 lymphocyte counts were measured and plasma samples were stored for analysis. HIV RNA load was determined retrospectively at baseline and 9 months after initiation of therapy.
The mean age of the children was 8.5 years (range: 2-16 years). At baseline, the mean CD4 count (+/-SD) was 182.3 x 10(6) cells per microL (+/-145.6). On treatment, CD4 counts increased step-wise by a mean of 187 x 10(6) cells per microL at 3 months, 293 cells per microL at 6 months, 308 cells per microL at 9 months, 334 cells per microL at 12 months, and 363 cells per microL at 15 months. The mean plasma viral load decreased from a baseline level of 622,712 to 35,369 copies per mL, and at 9 months was undetectable in 55% of the patients. Mean z scores for weight for age increased from a baseline of -1.61 to -1.12 at 12 months into therapy.
A public health approach using 1 treatment regimen in generic form showed excellent efficacy among treatment-naive, HIV-infected children in a resource-limited country. Clinical and immunologic improvement occurred in all patients, but 9 months after the start of therapy, only 55% of the children had an undetectable viral load.
在资源匮乏地区，针对感染HIV儿童的抗逆转录病毒疗法疗效的研究较少。本观察性回顾分析描述了在肯尼亚蒙巴萨，接受高效抗逆转录病毒疗法（HAART）的初治HIV感染儿童的临床、免疫和病毒学效果。为遵循公共卫生方法，所有儿童均采用简化的、国家批准的三联药物疗法进行治疗。
分析了2003年4月至2004年10月期间前瞻性随访的29名儿童的临床数据和储存的血浆样本。所有儿童均接受奈韦拉平、齐多夫定和拉米夫定的仿制药配方，并在基线以及第3、6、9、12和15个月进行评估。每次就诊时，测量体重和CD4淋巴细胞计数，并储存血浆样本用于分析。在基线和治疗开始后9个月回顾性测定HIV RNA载量。
儿童的平均年龄为8.5岁（范围：2至16岁）。基线时，平均CD4计数（±标准差）为每微升182.3×10⁶个细胞（±145.6）。治疗期间，CD4计数逐步增加，3个月时平均增加187×10⁶个细胞/微升，6个月时增加293个细胞/微升，9个月时增加308个细胞/微升，12个月时增加334个细胞/微升，15个月时增加363个细胞/微升。血浆病毒载量平均从基线水平的每毫升622,712拷贝降至35,369拷贝，在9个月时，55%的患者病毒载量检测不到。治疗12个月时，年龄别体重的平均z评分从基线的-1.61升至-1.12。
在一个资源有限的国家，采用一种通用剂型治疗方案的公共卫生方法在初治HIV感染儿童中显示出优异的疗效。所有患者的临床和免疫状况均有改善，但治疗开始9个月后，只有55%的儿童病毒载量检测不到。
