Africa Centre for Health and Population Studies, University of KwaZulu-Natal, KwaZulu-Natal, South Africa.
Arch Dis Child. 2010 Jun;95(6):414-21. doi: 10.1136/adc.2009.169367. Epub 2009 Oct 29.
Clinical outcomes of HIV-infected children on antiretroviral treatment (ART) in a decentralised, nurse/counsellor-led programme.
Clinical cohort.
KwaZulu-Natal, South Africa.
HIV-infected children aged <or=15 years on ART, June 2004-2008.
Survival according to baseline characteristics including age, WHO clinical stage, haemoglobin and CD4%, was assessed in Kaplan-Meier analyses. Hazard ratios for mortality were estimated using Cox proportional hazards regression and changes in laboratory parameters and weight-for-age z scores after 6-12 months' treatment were calculated.
477 HIV-infected children began ART at a median age of 74 months (range 4-180), median CD4 count (CD4%) of 433 cells/mm(3) (17%) and median HIV viral load of log 4.2 copies/ml; 105 (22%) were on treatment for tuberculosis and 317 (76.6%) were WHO stage 3/4. There were significant increases after ART initiation in CD4% (17% vs 22%; p<0.001), haemoglobin (9.9 vs 11.7 g/l; p<or=0.001) and albumin (30 vs 36 g/l; p<or=0.001). 32 (6.7%) children died over 732 child-years of follow-up (43.7 deaths/1000 child-years; 95% CI 32.7 to 58.2), 17 (53.1%) within 90 days of treatment initiation; median age of death was 84 (IQR 10-181) months. Children with baseline haemoglobin <or=8 g/l were more likely to die (adjusted HR 4.5; 95% CI 1.6 to 12.3), as were those aged <18 months compared with >60 months (adjusted HR 3.2; 95% CI 1.2 to 9.1).
Good clinical outcomes in HIV-infected children on ART are possible in a rural, decentralised service. Few young children are on ART, highlighting the urgent need to identify HIV-exposed infants.
在一个去中心化、护士/顾问主导的方案中，评估接受抗逆转录病毒治疗（ART）的艾滋病毒感染儿童的临床结局。
临床队列。
南非夸祖鲁-纳塔尔省。
2004 年 6 月至 2008 年期间，年龄<或=15 岁、接受 ART 的艾滋病毒感染儿童。
根据基线特征（包括年龄、世界卫生组织临床分期、血红蛋白和 CD4%）进行生存评估，采用 Kaplan-Meier 分析。使用 Cox 比例风险回归估计死亡率的危险比，并计算 6-12 个月治疗后实验室参数和体重-年龄 z 评分的变化。
477 名艾滋病毒感染儿童开始 ART 的中位年龄为 74 个月（范围 4-180），中位 CD4 计数（CD4%）为 433 个细胞/mm3（17%），中位 HIV 病毒载量为 log4.2 拷贝/ml；105 名（22%）正在接受结核病治疗，317 名（76.6%）为世界卫生组织 3/4 期。ART 启动后，CD4%（17%比 22%；p<0.001）、血红蛋白（9.9 比 11.7 g/l；p<或=0.001）和白蛋白（30 比 36 g/l；p<或=0.001）显著增加。732 个儿童年的随访中，有 32 名（6.7%）儿童死亡（43.7 例/1000 儿童年；95%CI 32.7 至 58.2），其中 17 名（53.1%）在治疗开始后 90 天内死亡；死亡的中位年龄为 84（IQR 10-181）个月。基线血红蛋白<或=8 g/l 的儿童更有可能死亡（调整后的 HR 4.5；95%CI 1.6 至 12.3），与>60 个月的儿童相比，<18 个月的儿童更有可能死亡（调整后的 HR 3.2；95%CI 1.2 至 9.1）。
在农村地区的去中心化服务中，接受抗逆转录病毒治疗的艾滋病毒感染儿童可以获得良好的临床结局。很少有幼儿接受 ART，这突出表明迫切需要发现艾滋病毒暴露的婴儿。
