Obimbo Elizabeth Maleche, Wamalwa Dalton, Richardson Barbara, Mbori-Ngacha Dorothy, Overbaugh Julie, Emery Sandra, Otieno Phelgona, Farquhar Carey, Bosire Rose, Payne Barbara Lohman, John-Stewart Grace
Department of Pediatrics, University of Nairobi, Nairobi, Kenya.
J Acquir Immune Defic Syndr. 2009 Jun 1;51(2):209-15. doi: 10.1097/qai.0b013e31819c16d8.
There is limited information regarding the pattern and correlates of viral replication in vertically HIV-1-infected children and its role on their outcomes in resource-limited settings.
HIV-1-infected infants were followed from birth to 24 months. Serial HIV-1 RNA levels were compared in infants infected in utero (<48 hours), peripartum (48 hours-1 month), and late postnatal (after 1 month). Cofactors for viral peak [highest viral load (VL) within 6 months of infection] and set point and mortality were determined.
Among 85 HIV-1-infected infants, 24 were infected in utero, 41 peripartum, 13 late postnatal; 7 had no 48-hour assay. HIV-1 VL set point was significantly lower in infants infected >1 month vs. < or = 1 month (5.59 vs. 6.24 log10 copies per milliliter, P = 0.01). Maternal VL correlated with peak infant VL (P < 0.001). Univariately, infant peak and set point VL and 6-month CD4% <15% predicted mortality; and 6-month CD4% <15% remained independently predictive in multivariate analyses (hazard ratio = 4.85, 95% confidence interval: 1.90 to 12.36).
Infants infected after the age of 1 month contained virus better than infants infected before 1 month of age. Maternal VL predicted infant VL, which, in turn was associated with early mortality.
在资源有限的环境中，关于垂直感染HIV-1的儿童病毒复制模式及其相关因素，以及其对儿童预后的作用，相关信息有限。
对HIV-1感染的婴儿从出生随访至24个月。比较宫内感染（<48小时）、围产期感染（48小时至1个月）和出生后晚期感染（1个月后）婴儿的系列HIV-1 RNA水平。确定病毒峰值[感染后6个月内的最高病毒载量（VL）]、设定点和死亡率的辅助因素。
在85例HIV-1感染婴儿中，24例为宫内感染，41例为围产期感染，13例为出生后晚期感染；7例未进行48小时检测。与感染≤1个月的婴儿相比（6.24 log10拷贝/毫升），感染>1个月的婴儿HIV-1 VL设定点显著更低（5.59 log10拷贝/毫升，P=0.01）。母亲的VL与婴儿的峰值VL相关（P<0.001）。单因素分析中，婴儿的峰值和设定点VL以及6个月时CD4%<15%可预测死亡率；多因素分析中，6个月时CD4%<15%仍具有独立预测性（风险比=4.85，95%置信区间：1.90至12.36）。
1个月龄后感染的婴儿比1个月龄前感染的婴儿病毒控制更好。母亲的VL可预测婴儿的VL，而婴儿的VL又与早期死亡率相关。
