Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America.
PLoS Med. 2011 Jun;8(6):e1001044. doi: 10.1371/journal.pmed.1001044. Epub 2011 Jun 14.
The effect of highly active antiretroviral therapy (HAART) on the survival of HIV-infected children has not been well quantified. Because most pediatric HIV occurs in low- and middle-income countries, our objective was to provide a first estimate of this effect among children living in a resource-deprived setting.
Observational data from HAART-naïve children enrolled into an HIV care and treatment program in Kinshasa, Democratic Republic of the Congo, between December 2004 and May 2010 were analyzed. We used marginal structural models to estimate the effect of HAART on survival while accounting for time-dependent confounders affected by exposure. At the start of follow-up, the median age of the 790 children was 5.9 y, 528 (66.8%) had advanced or severe immunodeficiency, and 405 (51.3%) were in HIV clinical stage 3 or 4. The children were observed for a median of 31.2 mo and contributed a total of 2,089.8 person-years. Eighty children (10.1%) died, 619 (78.4%) initiated HAART, six (0.8%) transferred to a different care provider, and 76 (9.6%) were lost to follow-up. The mortality rate was 3.2 deaths per 100 person-years (95% confidence interval [CI] 2.4-4.2) during receipt of HAART and 6.0 deaths per 100 person-years (95% CI 4.1-8.6) during receipt of primary HIV care only. The mortality hazard ratio comparing HAART with no HAART from a marginal structural model was 0.25 (95% CI 0.06-0.95).
HAART reduced the hazard of mortality in HIV-infected children in Kinshasa by 75%, an estimate that is similar in magnitude but with lower precision than the reported effect of HAART on survival among children in the United States. Please see later in the article for the Editors' Summary.
高效抗逆转录病毒疗法（HAART）对 HIV 感染儿童生存的影响尚未得到充分量化。由于大多数儿科 HIV 发生在低收入和中等收入国家，我们的目标是在资源匮乏的环境中为生活在这种环境中的儿童提供对此类影响的初步评估。
对 2004 年 12 月至 2010 年 5 月期间在刚果民主共和国金沙萨的 HIV 护理和治疗项目中入组的 HAART 初治儿童的观察性数据进行了分析。我们使用边缘结构模型来估计 HAART 对生存的影响，同时考虑到暴露受时间依赖性混杂因素的影响。在随访开始时，790 名儿童的中位年龄为 5.9 岁，528 名（66.8%）患有晚期或严重免疫缺陷，405 名（51.3%）处于 HIV 临床分期 3 或 4 期。儿童的中位随访时间为 31.2 个月，共贡献了 2089.8 人年。80 名（10.1%）儿童死亡，619 名（78.4%）开始接受 HAART，6 名（0.8%）转至其他护理提供者，76 名（9.6%）失访。接受 HAART 期间的死亡率为每 100 人年 3.2 例（95%CI 2.4-4.2），仅接受原发性 HIV 护理期间的死亡率为每 100 人年 6.0 例（95%CI 4.1-8.6）。边缘结构模型比较 HAART 与无 HAART 的死亡风险比为 0.25（95%CI 0.06-0.95）。
在金沙萨，HAART 将 HIV 感染儿童的死亡风险降低了 75%，这一估计值的幅度与美国儿童接受 HAART 后生存率的报告效果相似，但精度较低。请在文章后面查看编辑摘要。
