乌干达接受联合抗逆转录病毒疗法的全国儿科队列的临床和免疫结果

Clinical and immunological outcomes of a national paediatric cohort receiving combination antiretroviral therapy in Uganda.

作者信息

Kiboneka Andrew, Wangisi Jonathan, Nabiryo Christine, Tembe Juliet, Kusemererwa Sylvia, Olupot-Olupot Peter, Joffres Michel, Anema Aranka, Cooper Curtis L, Montaner Julio S, Mills Edward J

机构信息

The AIDS Support Organization, Kampala, Uganda.

出版信息

AIDS. 2008 Nov 30;22(18):2493-9. doi: 10.1097/QAD.0b013e328318f148.

DOI:10.1097/QAD.0b013e328318f148

PMID:19005272

Abstract

OBJECTIVE

We aimed to evaluate clinical and immunological outcomes of paediatric patients receiving combination antiretroviral therapy (cART) enrolled in The AIDS Support Organization (TASO) Uganda national HIV/AIDS programme.

DESIGN

Observational study of patients (age <14 years) enrolled in 10 clinics across Uganda for which TASO has data.

METHODS

We extracted patient demographic, immunological and clinical outcomes from the TASO databases regarding age, sex, cART regimen, CD4 cell count and WHO stage at initiation, tuberculosis, mortality and adherence. Outcomes were analysed using Pearson's rank-order correlations, Wilcoxon's rank sum tests, Cox proportional hazard model and survivor functions.

RESULTS

Of the total 770 HIV children on cART, median age was 9 years (interquartile range, 5-13 years), and median follow-up time was 377 days (interquartile range, 173-624 days). Seven hundred and fifty-one children (97.5%) initiated nonnucleoside reverse transcriptase inhibitor-based regimens. Three hundred and sixty-five children (47.5%) initiated cART with severe immune suppression (CD4 cell percentage <15). Of the 18 (2.3%) children that died, mortality was associated with lower CD4 cell percentage at initiation (B coefficient -0.144, standard error 0.06, P = 0.02). Of the total, 229 (30%) were single or double orphans and more likely to initiate cART at an older age (mean age, 9.25 vs. 8.35 years, P = 0.02) and have a lower CD4 cell count (median, 268 vs. 422 cells/microl, P < or = 0.0001) and CD4 cell percentage (median 12.8 vs. 15.5%, P = 0.02) at initiation. Pulmonary tuberculosis was present in 43 (5.6%) patients at initiation and 21 (2.3%) after cART. Almost all patients (94.9%) demonstrated more than 95% adherence.

CONCLUSION

Children on cART in Uganda demonstrate positive clinical outcomes. However, additional support is required to ensure timely cART access among orphans and young children.

摘要

目的

我们旨在评估参与乌干达艾滋病支持组织（TASO）国家艾滋病毒/艾滋病项目的接受联合抗逆转录病毒疗法（cART）的儿科患者的临床和免疫结果。

设计

对乌干达10家诊所中TASO有数据记录的患者（年龄<14岁）进行观察性研究。

方法

我们从TASO数据库中提取了患者的人口统计学、免疫学和临床结果，包括年龄、性别、cART方案、开始治疗时的CD4细胞计数和世界卫生组织疾病分期、结核病、死亡率和依从性。使用Pearson等级相关、Wilcoxon秩和检验、Cox比例风险模型和生存函数对结果进行分析。

结果

在接受cART治疗的770名艾滋病毒感染儿童中，年龄中位数为9岁（四分位间距，5 - 13岁），中位随访时间为377天（四分位间距，173 - 624天）。751名儿童（97.5%）开始使用基于非核苷类逆转录酶抑制剂的方案。365名儿童（47.5%）开始cART治疗时伴有严重免疫抑制（CD4细胞百分比<15%）。在18名（2.3%）死亡的儿童中，死亡率与开始治疗时较低的CD4细胞百分比相关（B系数 -0.144，标准误0.06，P = 0.02）。总体而言，229名（30%）是单亲或双亲孤儿，他们更有可能在较大年龄开始cART治疗（平均年龄，9.25岁对8.35岁，P = 0.02），并且开始治疗时CD4细胞计数较低（中位数，268对422个/微升，P≤0.0001）以及CD4细胞百分比较低（中位数12.8%对15.5%，P = 0.02）。开始治疗时43名（5.6%）患者患有肺结核，cART治疗后21名（2.3%）患有肺结核。几乎所有患者（94.9%）的依从性超过95%。