尼日利亚伊巴丹大学教学医院儿科人类免疫缺陷病毒感染的流行情况和临床特征：一项前瞻性横断面研究。
Prevalence and clinical pattern of paediatric HIV infection at the University College Hospital, Ibadan, Nigeria: a prospective cross-sectional study.
机构信息
Department of Paediatrics, University College Hospital, Ibadan, Nigeria.
出版信息
Ital J Pediatr. 2011 Jun 16;37:29. doi: 10.1186/1824-7288-37-29.
BACKGROUND
The prevalence of Paediatric HIV infection is largely unknown in many countries in sub-Saharan Africa. This study was aimed at determining the prevalence, clinical pattern of HIV infection and outcome among new patients aged <15 years using age-specific diagnostic methods.
METHODS
A prospective cross sectional study was carried out using the provider initiated HIV testing and counselling (PITC) model. HIV rapid test in parallel was used for screening and confirmation was with HIV DNA PCR in children <18 months and Western Blot in children ≥ 18 months.
RESULTS
A total of 600 children were enrolled with ages ranging between one day and 179 months. Male: female ratio was 1.2:1. HIV seroprevalence was 12.3% and after confirmatory tests, the prevalence was 10%. Fourteen (37.8%) of the children aged less 18 months were exposed but not infected. Mother-to-child transmission accounted for 93.3% of cases. Features predictive of HIV infection were diarrhoea, cough, weight loss, ear discharge generalized lymphadenopathy, presence of skin lesions, parotid swelling and oral thrush. About 75% presented in advanced or severe clinical stages of the disease, 56.8% had severe immunodeficiency while 50% had viral loads more than 100,000 copies/ml. Mortality rate was 14.3% among HIV positive compared with 11.3% in HIV negative children but was not significant. Among the HIV positive children, 26.7% were orphans.
CONCLUSIONS
The prevalence rate of HIV infection among new patients screened using the PITC model was high, majority resulting from mother-to-child transmission. Most children presented in advanced stages of the disease and mortality rate among them was high. Though, the study site being a referral centre might have contributed to the high prevalence observed in this study, there is a need to expand access to PMTCT services, ensure implementation of PITC in paediatric settings and expand support services for HIV infected children.
背景
在撒哈拉以南非洲的许多国家，儿童艾滋病毒感染的流行情况在很大程度上仍不为人知。本研究旨在采用特定年龄的诊断方法，确定新发病例中<15 岁儿童的艾滋病毒流行率、感染的临床模式和结局。
方法
采用提供者启动的艾滋病毒检测和咨询（PITC）模式进行前瞻性横断面研究。平行使用 HIV 快速检测进行筛查，HIV DNA PCR 检测<18 个月的儿童，免疫印迹法检测≥18 个月的儿童，以确认检测结果。
结果
共纳入 600 例年龄在 1 天至 179 个月之间的儿童。男童与女童比例为 1.2:1。HIV 血清阳性率为 12.3%，经确认性试验后，阳性率为 10%。14 例（37.8%）<18 个月的儿童有暴露史但未感染。母婴传播占 93.3%的病例。HIV 感染的预测特征包括腹泻、咳嗽、体重减轻、耳溢、全身淋巴结肿大、皮肤损伤、腮腺肿胀和口腔鹅口疮。约 75%的患儿处于疾病的晚期或严重阶段，56.8%的患儿严重免疫缺陷，50%的患儿病毒载量>100000 拷贝/ml。与 HIV 阴性患儿相比，HIV 阳性患儿的死亡率为 14.3%，但差异无统计学意义。在 HIV 阳性患儿中，26.7%是孤儿。
结论
采用 PITC 模型筛查的新发病例中，HIV 感染的流行率较高，主要来自母婴传播。大多数患儿处于疾病的晚期，死亡率较高。然而，研究地点是一个转诊中心，这可能导致了该研究中观察到的高流行率，有必要扩大 PMTCT 服务的可及性，确保在儿科环境中实施 PITC，并扩大对 HIV 感染儿童的支持服务。
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