Taye Bineyam, Shiferaw Solomon, Enquselassie Fikre
School of Clinical Laboratory Science, Addis Ababa University.
Ethiop Med J. 2010 Jan;48(1):1-10.
Malnutrition is a common condition in HIV-infected children; however, its impact in survival of HIV infected children after initiation ofantiretroviral therapy is not well understood.
To assess the impact of malnutrition in survival of HIV infected children after initiation of antiretroviral treatment.
A retrospective cohort study was conducted in HIV infected children starting antiretroviral treatment at Zewditu memorial hospital, Addis Ababa, Ethiopia. Demographic, nutritional, clinical and immunological data were carefully extracted from the existing ART logbook and patient follow up cards. Accordingly, nutritional status were defined with stunting (height for age Z score < -2), Wasting (weight for height Z score -2) and under weight (weight for age Z score < -2). Survival was defined as the tidne from nutritional and immunologic evaluation to death. Data were analyzed for univariate and multivariate analysis using Cox regression proportional hazard model. Survival rate was calculated and compare with the Kaplan Meier and log rank tests.
A total of 475 HIV infected children starting antiretroviral treatment (ART) from March 21 2005 to 30 April 2008 were included in the study. Of whom 42 (8.8%) died during a median study follow up of 12 months. The average survival time for the entire cohort was 27.9 months. Independent baseline predictors of mortality were severe wasting (Hazard ratio (HR) = 4.99, 95% CI 2.4-10.2, P < 0.00), absolute CD4 below the threshold for severe immunodeficiency (HR = 3.02, 95% CI 1.02-8.96, P = 0.04) and low hemoglobin value (HR = 2.92, 95% CI 1.3-6.7, P = 0.001 for those hemoglobin value < 7.0 gm/dl). The probability of surviving for wasted children declines sharply starting from 6th months and reach 76% in 12th months.
Despite the apparent benefit of ART use HIV related survival, severe wasting (WHZ < -3) appear to be strong independent predictor of survival in HIV infected children receiving ART.
营养不良是感染艾滋病毒儿童的常见状况；然而，其对感染艾滋病毒儿童在开始抗逆转录病毒治疗后的生存影响尚不清楚。
评估营养不良对感染艾滋病毒儿童在开始抗逆转录病毒治疗后的生存影响。
在埃塞俄比亚亚的斯亚贝巴的泽韦迪图纪念医院，对开始接受抗逆转录病毒治疗的感染艾滋病毒儿童进行了一项回顾性队列研究。从现有的抗逆转录病毒治疗日志和患者随访卡中仔细提取了人口统计学、营养、临床和免疫学数据。据此，营养状况定义为发育迟缓（年龄别身高Z评分＜-2）、消瘦（身高别体重Z评分＜-2）和体重不足（年龄别体重Z评分＜-2）。生存定义为从营养和免疫评估到死亡的时间。使用Cox回归比例风险模型对数据进行单变量和多变量分析。计算生存率，并与Kaplan-Meier法和对数秩检验进行比较。
2005年3月21日至2008年4月30日期间开始接受抗逆转录病毒治疗（ART）的475名感染艾滋病毒儿童纳入了研究。其中42名（8.8%）在中位研究随访12个月期间死亡。整个队列的平均生存时间为27.9个月。死亡率的独立基线预测因素为严重消瘦（风险比（HR）=4.99，95%置信区间2.4-10.2，P＜0.00）、绝对CD4低于严重免疫缺陷阈值（HR=3.02，95%置信区间1.02-8.96，P=0.04）和低血红蛋白值（对于血红蛋白值＜7.0g/dl者，HR=2.92，95%置信区间1.3-6.7，P=0.001）。消瘦儿童的生存概率从第6个月开始急剧下降，在第12个月时降至76%。
尽管抗逆转录病毒治疗对艾滋病毒相关生存有明显益处，但严重消瘦（WHZ＜-3）似乎是接受抗逆转录病毒治疗的感染艾滋病毒儿童生存的强有力独立预测因素。
