Department of Epidemiology, Harvard School of Public Health, Boston, MA 02115, USA.
AIDS. 2009 Sep 10;23(14):1893-901. doi: 10.1097/QAD.0b013e32832dc041.
Prior to antiretroviral treatment, HIV-infected children frequently developed encephalopathy, resulting in debilitating morbidity and mortality. This is the first large study to evaluate the impact of HAART and central nervous system (CNS)-penetrating antiretroviral regimens on the incidence of HIV encephalopathy and survival after diagnosis of HIV encephalopathy among perinatally infected children.
A total of 2398 perinatally HIV-infected children with at least one neurological examination were followed in a US-based prospective cohort study conducted from 1993 to 2007.
Trends in incidence rates over calendar time were described and Cox regression models were used to estimate the effects of time-varying HAART and CNS-penetrating antiretroviral regimens on HIV encephalopathy and on survival after diagnosis of HIV encephalopathy.
During a median of 6.4 years of follow-up, 77 incident cases of HIV encephalopathy occurred [incidence rate 5.1 cases per 1000 person-years, 95% confidence interval (CI) 4.0-6.3]. A 10-fold decline in incidence was observed beginning in 1996, followed by a stable incidence rate after 2002. HAART regimens were associated with a 50% decrease (95% CI 14-71%) in the incidence of HIV encephalopathy compared with non-HAART regimens. High CNS-penetrating regimens were associated with a substantial survival benefit (74% reduction in the risk of death, 95% CI 39-89%) after HIV encephalopathy diagnosis compared with low CNS-penetrating regimens.
A dramatic decrease in the incidence of HIV encephalopathy occurred after the introduction of HAART. The use of HAART was highly effective in reducing the incidence of HIV encephalopathy among perinatally infected children and adolescents. Effective CNS-penetrating antiretroviral regimens are important in affecting survival after diagnosis of HIV encephalopathy.
在接受抗逆转录病毒治疗之前，HIV 感染儿童经常出现脑病，导致衰弱性发病率和死亡率。这是第一项评估高效抗逆转录病毒治疗和中枢神经系统（CNS）穿透性抗逆转录病毒方案对围生期感染儿童 HIV 脑病发病率和诊断后 HIV 脑病生存的影响的大型研究。
一项在美国进行的前瞻性队列研究，从 1993 年至 2007 年共纳入了 2398 名至少接受过一次神经系统检查的围生期 HIV 感染儿童。
描述了随时间推移发病率的趋势，并使用 Cox 回归模型估计了时间变化的高效抗逆转录病毒治疗和中枢神经系统穿透性抗逆转录病毒方案对 HIV 脑病和诊断后 HIV 脑病生存的影响。
在中位 6.4 年的随访期间，共发生了 77 例 HIV 脑病新发病例[发病率为每 1000 人年 5.1 例，95%置信区间（CI）为 4.0-6.3]。1996 年开始观察到发病率下降了 10 倍，随后在 2002 年后发病率稳定。与非高效抗逆转录病毒治疗方案相比，高效抗逆转录病毒治疗方案与 HIV 脑病发病率降低 50%相关（95%CI 14-71%）。与低 CNS 穿透性方案相比，高 CNS 穿透性方案与 HIV 脑病诊断后生存率显著提高（死亡风险降低 74%，95%CI 39-89%）相关。
高效抗逆转录病毒治疗的引入使 HIV 脑病的发病率显著下降。高效抗逆转录病毒治疗方案在降低围生期感染儿童和青少年 HIV 脑病发病率方面非常有效。有效的中枢神经系统穿透性抗逆转录病毒方案对诊断后 HIV 脑病的生存有重要影响。
