Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
AIDS. 2010 Jan 2;24(1):139-46. doi: 10.1097/QAD.0b013e328332d5ca.
Construct percentile curves for 6-month gain in weight, height, CD4 cell count, and CD4 percentage (CD4%) in children initiating ART, and to assess the association between lower percentiles and subsequent ART responses.
Cohort of 1394 HIV-infected children initiating ART between April 2004 and March 2008, Johannesburg, South Africa
The generalized additive model for location, scale, and shape was used to construct percentile curves for 6-month gain in weight, height, CD4 cell count, and CD4%. Cox proportional models were used to assess the association between lower percentiles of each distribution and death, virological suppression, and treatment failure between 6 to 36 months post-ART initiation.
Lower percentiles for gain in weight, CD4, and CD4% count after 6 months of ART, but not height, were associated with poor subsequent treatment outcomes independent of baseline characteristics, with increasing strength of association as percentiles decreased. Age-specific 6-month post-ART weight gain in our cohort was substantially higher compared with 6-month weight gain in non-HIV-infected American children of the Fels Institute cohort and the attained weight-for-age at 6 months post-ART plotted on WHO weight-for-age growth charts were not associated with subsequent treatment outcomes.
Gain in CD4% in the first 6 months of ART was the best predictor of poor subsequent ART outcomes. In areas with limited access to CD4%, weight gain post-ART using our newly developed reference distributions for HIV-infected children on ART is a good alternative to CD4%, and clearly superior to the commonly used 'Road-to-Health' weight-for-age charts.
构建开始接受抗逆转录病毒疗法（ART）的儿童体重、身高、CD4 细胞计数和 CD4%（CD4%）在 6 个月内增长的百分位数曲线，并评估较低百分位数与随后 ART 反应之间的关系。
2004 年 4 月至 2008 年 3 月期间，南非约翰内斯堡开始接受抗逆转录病毒疗法的 1394 名 HIV 感染儿童的队列研究。
使用位置、比例和形状的广义加性模型来构建体重、身高、CD4 细胞计数和 CD4%在 6 个月内增长的百分位数曲线。Cox 比例风险模型用于评估每个分布的较低百分位数与死亡、病毒学抑制和开始 ART 后 6 至 36 个月内治疗失败之间的关系。
ART 后 6 个月体重、CD4 和 CD4%计数的较低百分位数与随后的治疗结局不良相关，与基线特征无关，随着百分位数的降低，关联强度增加。与 Fels 研究所队列中非 HIV 感染美国儿童的 6 个月体重相比，我们队列中年龄特异性的 ART 后 6 个月体重增长明显更高，并且在开始 ART 后 6 个月绘制的 WHO 体重年龄生长图表上的获得体重与随后的治疗结局无关。
ART 后前 6 个月内 CD4%的增长是预测随后 ART 结局不良的最佳指标。在 CD4%获取有限的地区，使用我们新开发的针对开始接受抗逆转录病毒疗法的 HIV 感染儿童的参考分布进行 ART 后的体重增长是 CD4%的良好替代方法，明显优于常用的“通往健康之路”体重年龄图表。
