Assistance Publique-Hôpitaux de Paris (AP-HP), Service d'Hématologie et d'Oncologie Pédiatrique, Hôpital d'Enfants Armand Trousseau, Le Kremlin-Bicêtre, France.
Clin Infect Dis. 2010 Jul 15;51(2):214-24. doi: 10.1086/653674.
BACKGROUND. Increasing numbers of children perinatally infected with human immunodeficiency virus (HIV) are reaching adolescence, largely because of advances in treatment over the past 10 years, but little is known about their current health status. We describe here the living conditions and clinical and immunovirologic outcomes at last evaluation among this pioneering generation of adolescents who were born before the introduction of prophylaxis for vertical transmission and whose infections were diagnosed at a time when treatment options were limited. METHODS. The eligible population consisted of HIV-1-infected children who were born before December 1993 and who were included at birth in the prospective national French Perinatal Cohort (EPF/ANRS CO10). RESULTS. Of the 348 eligible children, 210 (60%; median age, 15 years) were still alive and regularly followed up. Current treatment was highly active antiretroviral therapy (HAART) in 77% and 2 nucleoside analogues in 5.0%; 16% had stopped treatment, and 2% had never been treated. The median CD4 cell count was 557 cells/microL, and 200 cells/microL was exceeded in 94% of patients. The median viral load was 200 copies/mL. Viral load was undetectable in 43% of the adolescents and in 54.5% of those receiving HAART. Median height, weight, and body mass index were similar to French reference values for age, and school achievement was similar to nationwide statistics. Better immunologic status was associated with being younger and with having begun HAART earlier. Undetectable viral load was associated with maternal geographic origin and current HAART. CONCLUSIONS. Given the limited therapeutic options available during the early years of these patients' lives and the challenge presented by treatment adherence during adolescence, the long-term outcomes among this population are encouraging.
由于过去 10 年来治疗方面的进步，越来越多的儿童在围产期感染了人类免疫缺陷病毒（HIV），他们正进入青春期，但目前对他们的健康状况知之甚少。我们在此描述了这一代开创性青少年的生活条件以及最后一次评估时的临床和免疫病毒学结果，这些青少年在预防垂直传播的措施推出之前出生，并且在诊断时治疗方案有限。
合格人群包括在 1993 年 12 月之前出生并且在出生时就参与了前瞻性法国围产期队列（EPF/ANRS CO10）的 HIV-1 感染儿童。
在 348 名合格的儿童中，有 210 名（60%；中位年龄 15 岁）仍然存活并定期接受随访。目前的治疗方法是高度活性抗逆转录病毒疗法（HAART）占 77%，2 种核苷类似物占 5.0%；16%已停止治疗，2%从未接受过治疗。中位 CD4 细胞计数为 557 个细胞/微升，94%的患者的 CD4 细胞计数超过 200 个细胞/微升。中位病毒载量为 200 拷贝/毫升。43%的青少年和接受 HAART 的青少年中有 54.5%的病毒载量不可检测。身高、体重和体重指数的中位数与法国年龄参考值相似，学业成绩与全国统计数据相似。更好的免疫状态与年龄较小和更早开始 HAART 有关。不可检测的病毒载量与母婴的地理起源和目前的 HAART 有关。
考虑到这些患者生命早期治疗方案有限，以及在青少年时期治疗依从性带来的挑战，该人群的长期结果令人鼓舞。
