Read Jennifer S, Mwatha Anthony, Richardson Barbra, Valentine Megan, Emel Lynda, Manji Karim, Hoffman Irving, Sharma Usha, Goldenberg Robert L, Taha Taha E
Pediatric, Adolescent, and Maternal AIDS Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Department of Health and Human Services, Bethesda, MD 20892-7510, USA.
J Acquir Immune Defic Syndr. 2009 Jul 1;51(3):317-22. doi: 10.1097/QAI.0b013e31819c18c3.
Our objectives were to assess clinical signs and diagnoses associated with primary HIV-1 infection among infants.
We analyzed data from a clinical trial (HIV Prevention Trials Network Protocol 024) in sub-Saharan Africa. Study visits were conducted at birth, at 4-6 weeks, and at 3, 6, 9, and 12 months. The study population comprised live born, singleton, first-born infants of HIV-1-infected women with negative HIV-1 RNA assays who were still breastfeeding at 4-6 weeks.
Of 1317 HIV-1-exposed infants, 84 became HIV-1 infected after 4-6 weeks and 1233 remained uninfected. There were 102 primary and 5650 nonprimary infection visits. The most common signs were cough and diarrhea, and the most common diagnoses were malaria and pneumonia. Primary infection was associated with significantly increased odds of diarrhea [odds ratio (OR) = 2.4], pneumonia (OR = 3.5), otitis media (OR = 3.1), and oral thrush (OR = 2.9). For the clinical signs and diagnoses evaluated, sensitivity was low (1%-16.7%) and specificity was high (88.2%-99%). Positive predictive values ranged from 0.1%-1.4%. Negative predictive values ranged from 28.0%-51.1%.
Certain clinical signs and diagnoses, although more common during primary HIV-1 infection, had low sensitivity and high specificity. Efforts to expand access to laboratory assays for the diagnosis of primary HIV-1 infection among infants of HIV-1-infected women should be emphasized.
我们的目的是评估婴儿原发性HIV-1感染相关的临床体征和诊断。
我们分析了撒哈拉以南非洲一项临床试验（HIV预防试验网络方案024）的数据。在出生时、4-6周时以及3、6、9和12个月时进行研究访视。研究人群包括HIV-1感染女性的活产、单胎、头胎婴儿，这些婴儿在4-6周时HIV-1 RNA检测为阴性且仍在母乳喂养。
在1317名暴露于HIV-1的婴儿中，84名在4-6周后感染了HIV-1，1233名仍未感染。有102次原发性感染访视和5650次非原发性感染访视。最常见的体征是咳嗽和腹泻，最常见的诊断是疟疾和肺炎。原发性感染与腹泻（优势比[OR]=2.4）、肺炎（OR=3.5）、中耳炎（OR=3.1）和鹅口疮（OR=2.9）的显著增加的几率相关。对于所评估的临床体征和诊断，敏感性较低（1%-16.7%），特异性较高（88.2%-99%）。阳性预测值范围为0.1%-1.4%。阴性预测值范围为28.0%-51.1%。
某些临床体征和诊断，虽然在原发性HIV-1感染期间更常见，但敏感性低且特异性高。应强调努力扩大对HIV-1感染女性婴儿原发性HIV-1感染诊断的实验室检测的可及性。
