Resino Salvador, Micheloud Dariela, Larrú Beatriz, Bellón Jose M, Léon Juan Antonio, Resino Rosa, De José M Isabel, Gutiérrez M Dolores Gurbindo, Mellado M José, Guillen Sara, Ramos José Tomas, Muñoz-Fernández M Angeles
Laboratorio de Inmuno-Biología Molecular, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
AIDS Res Hum Retroviruses. 2008 Dec;24(12):1477-84. doi: 10.1089/aid.2008.0037.
Little is known about immunologic reconstitution in children on highly active antiretroviral treatment (HAART) during very long-term periods. A retrospective study was carried out to assess the effectiveness and development of metabolic disorders after very long-term periods on HAART in HIV-infected children with severe immunodeficiency. We included 55 children who were stratified into three groups according to %CD4(+) pre-HAART and rate of immunologic recovery: (1) S1-Rec: CD4(+) < or =5% at baseline and slow immunologic recovery; (2) S2-Rec: CD4(+) 5-15% at baseline and slow immunologic recovery; (3) R-Rec: CD4(+) < or =15% at baseline and rapid immunologic recovery (reference group). An adequate immune recovery after 8 years on HAART was achieved by only 25% of children. S1-Rec never achieved a mean of CD4(+) > or =25% after 8 years on HAART. All children had a significant increase in plasma cholesterol levels during the first 2 years. Afterward, cholesterol levels reached a plateau and remained stable until year 8 of follow-up. Higher rates of lipodystrophy were found in the R-Rec group [14 (100%)] than in the S1-Rec group [9/19 (47.4%)] or the S2-Rec group [13/20 (65%)] at the end of the study (p = 0.006). Overall, having a low nadir of CD4(+) hindered immune reconstitution; however, children with rapid immunologic recovery showed a higher prevalence of the lipodystrophy syndrome.
对于接受高效抗逆转录病毒治疗（HAART）的儿童在极长期内的免疫重建情况，我们所知甚少。我们开展了一项回顾性研究，以评估重度免疫缺陷的HIV感染儿童在接受极长期HAART治疗后的疗效及代谢紊乱的发展情况。我们纳入了55名儿童，根据HAART治疗前CD4(+)百分比和免疫恢复率将其分为三组：（1）S1-Rec组：基线时CD4(+)≤5%且免疫恢复缓慢；（2）S2-Rec组：基线时CD4(+)为5%-15%且免疫恢复缓慢；（3）R-Rec组：基线时CD4(+)≤15%且免疫恢复迅速（参照组）。接受HAART治疗8年后，只有25%的儿童实现了充分的免疫恢复。S1-Rec组在接受HAART治疗8年后，CD4(+)均值从未达到≥25%。所有儿童在治疗的前两年血浆胆固醇水平均显著升高。此后，胆固醇水平达到平台期并保持稳定，直至随访的第8年。在研究结束时，R-Rec组[14例（100%）]的脂肪代谢障碍发生率高于S1-Rec组[19例中的9例（47.4%）]或S2-Rec组[20例中的13例（65%）]（p = 0.006）。总体而言，CD4(+)最低点较低会阻碍免疫重建；然而，免疫恢复迅速的儿童脂肪代谢障碍综合征的患病率更高。
