抗逆转录病毒治疗后儿科人群的结局：资源有限国家和发达国家的比较。
Post-HAART outcomes in pediatric populations: comparison of resource-limited and developed countries.
机构信息
University of Washington School of Medicine, Seattle, Washington 98195-6340, USA.
出版信息
Pediatrics. 2011 Feb;127(2):e423-41. doi: 10.1542/peds.2009-2701. Epub 2011 Jan 24.
CONTEXT
No formal comparison has been made between the pediatric post-highly active antiretroviral therapy (HAART) outcomes of resource-limited and developed countries.
OBJECTIVE
To systematically quantify and compare major baseline characteristics and clinical end points after HAART between resource-limited and developed settings.
METHODS
Published articles and abstracts (International AIDS Society 2009, Conference on Retroviruses and Opportunistic Infections 2010) were examined from inception (first available publication for each search engine) to March 2010. Publications that contained data on post-HAART mortality, weight-for-age z score (WAZ), CD4 count, or viral load (VL) changes in pediatric populations were reviewed. Selected studies met the following criteria: (1) patients were younger than 21 years; (2) HAART was given (≥ 3 antiretroviral medications); and (3) there were >20 patients. Data were extracted for baseline age, CD4 count, VL, WAZ, and mortality, CD4 and virologic suppression over time. Studies were categorized as having been performed in a resource-limited country (RLC) or developed country (DC) on the basis of the United Nations designation. Mean percentage of deaths per cohort and deaths per 100 child-years, baseline CD4 count, VL, WAZ, and age were calculated for RLCs and DCs and compared by using independent samples t tests.
RESULTS
Forty RLC and 28 DC publications were selected (N = 17 875 RLCs; N = 1835 DC). Mean percentage of deaths per cohort and mean deaths per 100 child-years after HAART were significantly higher in RLCs than DCs (7.6 vs 1.6, P < .001, and 8.0 vs 0.9, P < .001, respectively). Mean baseline CD4% was 12% in RLCs and 23% in DCs (P = .01). Mean baseline VLs were 5.5 vs 4.7 log(10) copies per mL in RLCs versus DCs (P < .001).
CONCLUSIONS
Baseline CD4% and VL differ markedly between DCs and RLCs, as does mortality after pediatric HAART. Earlier diagnosis and treatment of pediatric HIV in RLCs would be expected to result in better HAART outcomes.
背景
尚未对资源有限国家和发达国家的儿科患者接受高效抗逆转录病毒治疗（HAART）后的结果进行正式比较。
目的
系统地量化和比较资源有限国家和发达国家的 HAART 后主要基线特征和临床终点。
方法
从首次发表（每个搜索引擎的首次可用出版物）到 2010 年 3 月，检查了已发表的文章和摘要（国际艾滋病协会 2009 年会议，逆转录病毒和机会性感染会议 2010 年）。审查了包含儿科人群接受 HAART 后死亡率、体重与年龄 z 评分（WAZ）、CD4 计数或病毒载量（VL）变化数据的出版物。选定的研究符合以下标准：（1）患者年龄小于 21 岁；（2）接受了 HAART（≥3 种抗逆转录病毒药物）；（3）>20 名患者。提取基线年龄、CD4 计数、VL、WAZ 和死亡率、CD4 和病毒学抑制的时间数据。根据联合国的指定，将研究归类为在资源有限国家（RLC）或发达国家（DC）进行。计算 RLC 和 DC 每队列的死亡率百分比和每 100 儿童年的死亡率、基线 CD4 计数、VL、WAZ 和年龄，并通过独立样本 t 检验进行比较。
结果
选择了 40 项 RLC 和 28 项 DC 出版物（RLC 组 N=17875 例；DC 组 N=1835 例）。HAART 后，RLC 每队列的死亡率百分比和每 100 儿童年的死亡率明显高于 DC（7.6%比 1.6%，P<.001，8.0%比 0.9%，P<.001）。RLC 的基线 CD4%为 12%，而 DC 的为 23%（P=.01）。RLC 的基线 VL 为 5.5log10 拷贝/mL，而 DC 的为 4.7log10 拷贝/mL（P<.001）。
结论
DC 和 RLC 之间的基线 CD4%和 VL 差异显著，儿科患者接受 HAART 后的死亡率也存在差异。在 RLC 中更早地诊断和治疗儿科 HIV ，预计会产生更好的 HAART 结果。
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