Ndondoki Camille, Dabis François, Namale Leticia, Becquet Renaud, Ekouevi Didier, Bosse-Amani Clarisse, Arrivé Elise, Leroy Valériane
Université Victor-Segalen Bordeaux 2, institut de santé publique, d'épidémiologie et de développement (ISPED), 33076 Bordeaux, France.
Presse Med. 2011 Jul-Aug;40(7-8):e338-57. doi: 10.1016/j.lpm.2010.11.02. Epub 2011 Feb 3.
With 2.1 million HIV-infected children in 2008 in the world, especially in sub-Saharan Africa, the paediatric HIV/AIDS care remains an important public health challenge and is principally based on cotrimoxazole prophylaxis and antiretroviral treatments. This paper aims to review the effectiveness of cotrimoxole prophylaxis and antiretroviral treatment in HIV-infected children in Africa, specifically mortality and treatment outcomes.
In two times, we searched the online databases PubMed™ and Scopus™ for articles and abstracts published in English and French between January 2004 and November 2009, with the following terms : « HIV » and « Africa » and ["paediatric" or "children" or "child"] and ["mortality" or "survival"] and ["cotrimoxazole" or "prophylaxis"] at the first time, « HIV » and « Africa » and ["paediatric" or "children" or "child"] and ["mortality" or "survival"] and ["antiretroviral"] and ["treatment" or "therapy"] at the second time. Longitudinal studies on HIV-infected children under cotrimoxazole prophylaxis or antiretroviral treatment were selected when survival outcomes were reported.
The probability of death was significantly reduced by 43% where children received cotrimoxazole prophylaxis compared to placebo. Compared to the survival without treatment, the benefit of antiretroviral therapy on HIV-infected children survival was evident in all publications but early mortality was observed within the six first months of antiretroviral treatment. Over fifty percent of deaths occurred in this period. Severe malnutrition, anaemia and lower CD4% were identified as mortality predicting factors in both children received cotrimoxazole prophylaxis or treated by antiretroviral therapy.
Better knowledge of determinants of early mortality for these children are important to optimized their survival and improve their quality of care and life. Finally, the beneficial effect of cotrimoxazole prophylaxis when associated with antiretroviral treatment has not been reported and need to be exploring in detail for more information.
2008年全球有210万感染艾滋病毒的儿童，尤其是在撒哈拉以南非洲地区，儿科艾滋病毒/艾滋病护理仍然是一项重大的公共卫生挑战，主要基于复方新诺明预防和抗逆转录病毒治疗。本文旨在综述复方新诺明预防和抗逆转录病毒治疗对非洲感染艾滋病毒儿童的有效性，特别是死亡率和治疗结果。
我们分两次在在线数据库PubMed™和Scopus™中搜索2004年1月至2009年11月期间以英文和法文发表的文章和摘要，第一次使用以下检索词：“艾滋病毒”和“非洲”以及["儿科"或"儿童"或"小孩"]和["死亡率"或"生存率"]和["复方新诺明"或"预防"]，第二次使用“艾滋病毒”和“非洲”以及["儿科"或"儿童"或"小孩"]和["死亡率"或"生存率"]和["抗逆转录病毒"]和["治疗"或"疗法"]。当报告生存结果时，选择关于接受复方新诺明预防或抗逆转录病毒治疗的感染艾滋病毒儿童的纵向研究。
与接受安慰剂的儿童相比，接受复方新诺明预防的儿童死亡概率显著降低了43%。与未接受治疗的生存情况相比，抗逆转录病毒疗法对感染艾滋病毒儿童生存的益处在所有出版物中都很明显，但在抗逆转录病毒治疗的头六个月内观察到早期死亡情况。超过50%的死亡发生在此期间。严重营养不良、贫血和较低的CD4%被确定为接受复方新诺明预防或接受抗逆转录病毒治疗的儿童的死亡预测因素。
更好地了解这些儿童早期死亡的决定因素对于优化他们的生存以及改善他们的护理和生活质量非常重要。最后，复方新诺明预防与抗逆转录病毒治疗联合使用的有益效果尚未见报道，需要进行详细探索以获取更多信息。
