London School of Hygiene & Tropical Medicine, London, United Kingdom.
PLoS Med. 2010 Feb 2;7(2):e1000178. doi: 10.1371/journal.pmed.1000178.
Survival to older childhood with untreated, vertically acquired HIV infection, which was previously considered extremely unusual, is increasingly well described. However, the overall impact on adolescent health in settings with high HIV seroprevalence has not previously been investigated.
Adolescents (aged 10-18 y) systematically recruited from acute admissions to the two public hospitals in Harare, Zimbabwe, answered a questionnaire and underwent standard investigations including HIV testing, with consent. Pre-set case-definitions defined cause of admission and underlying chronic conditions. Participation was 94%. 139 (46%) of 301 participants were HIV-positive (median age of diagnosis 12 y: interquartile range [IQR] 11-14 y), median CD4 count = 151; IQR 57-328 cells/microl), but only four (1.3%) were herpes simplex virus-2 (HSV-2) positive. Age (median 13 y: IQR 11-16 y) and sex (57% male) did not differ by HIV status, but HIV-infected participants were significantly more likely to be stunted (z-score<-2: 52% versus 23%, p<0.001), have pubertal delay (15% versus 2%, p<0.001), and be maternal orphans or have an HIV-infected mother (73% versus 17%, p<0.001). 69% of HIV-positive and 19% of HIV-negative admissions were for infections, most commonly tuberculosis and pneumonia. 84 (28%) participants had underlying heart, lung, or other chronic diseases. Case fatality rates were significantly higher for HIV-related admissions (22% versus 7%, p<0.001), and significantly associated with advanced HIV, pubertal immaturity, and chronic conditions.
HIV is the commonest cause of adolescent hospitalisation in Harare, mainly due to adult-spectrum opportunistic infections plus a high burden of chronic complications of paediatric HIV/AIDS. Low HSV-2 prevalence and high maternal orphanhood rates provide further evidence of long-term survival following mother-to-child transmission. Better recognition of this growing phenomenon is needed to promote earlier HIV diagnosis and care.
未经治疗、垂直获得的 HIV 感染的儿童存活至较大年龄，这在以前被认为是极其罕见的，但在 HIV 血清阳性率较高的环境中，这种情况对青少年健康的总体影响尚未得到调查。
系统招募来自津巴布韦哈拉雷的两家公立医院急性住院的青少年（年龄 10-18 岁），在同意的情况下回答问卷并接受包括 HIV 检测在内的标准检查。预设的病例定义定义了入院的原因和潜在的慢性疾病。参与率为 94%。301 名参与者中有 139 名（46%）HIV 阳性（中位诊断年龄 12 岁：四分位距 [IQR] 11-14 岁），中位 CD4 计数=151；IQR 57-328 个细胞/微升），但只有 4 人（1.3%）单纯疱疹病毒 2 型（HSV-2）阳性。年龄（中位数 13 岁：IQR 11-16 岁）和性别（57%为男性）与 HIV 状态无关，但感染 HIV 的参与者明显更容易发育迟缓（z 评分<-2：52%对 23%，p<0.001）、青春期延迟（15%对 2%，p<0.001）、孤儿或感染 HIV 的母亲（73%对 17%，p<0.001）。69%的 HIV 阳性和 19%的 HIV 阴性入院是为了治疗感染，最常见的是结核病和肺炎。84 名（28%）参与者有心脏、肺部或其他慢性疾病。与 HIV 相关的入院死亡率明显更高（22%对 7%，p<0.001），与 HIV 晚期、青春期不成熟和慢性疾病显著相关。
HIV 是哈拉雷青少年住院的最常见原因，主要是由于成人范围的机会性感染以及儿科 HIV/AIDS 的慢性并发症负担较高。HSV-2 发病率低和孤儿母亲率高进一步证明了母婴传播后长期存活。需要更好地认识这一日益严重的现象，以促进更早的 HIV 诊断和护理。
Zotero 插件