临床参数在南非识别十岁以下婴儿 HIV 感染中的作用：一项前瞻性队列研究。

Utility of clinical parameters to identify HIV infection in infants below ten weeks of age in South Africa: a prospective cohort study.

机构信息

Children's Infectious Diseases Clinical Research Unit, Department of Paediatrics and Child Health and Centre for Infectious Diseases, Stellenbosch University, Tygerberg, South Africa.

出版信息

BMC Pediatr. 2011 Nov 21;11:104. doi: 10.1186/1471-2431-11-104.

DOI:10.1186/1471-2431-11-104

PMID:22103994

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3258191/

Abstract

BACKGROUND

As HIV-infected infants have high mortality, the World Health Organization now recommends initiating antiretroviral therapy as early as possible in the first year of life. However, in many settings, laboratory diagnosis of HIV in infants is not readily available. We aimed to develop a clinical algorithm for HIV presumptive diagnosis in infants < 10 weeks old using screening data from the Children with HIV Early Antiretroviral therapy (CHER) study in South Africa.HIV-infected and HIV-uninfected exposed infants < 10 weeks of age were identified through Vertical Transmission Prevention programs. Clinical and laboratory data were systematically recorded, groups were compared using Kruskal-Wallis, analysis of variance (ANOVA), and Fisher's exact tests. Receiver Operating Characteristic (ROC) curves were compiled using combinations of clinical findings.

RESULTS

417 HIV-infected and 125 HIV-exposed, uninfected infants, median age 46 days (IQR 38-55), were included. The median CD4 percentage in HIV-infected infants was 34 (IQR 28-41)%. HIV-infected infants had lower weight-for-age, more lymphadenopathy, oral thrush, and hepatomegaly than exposed uninfected infants (Adjusted Odds Ratio 0.51, 8.8, 5.6 and 23.5 respectively; p < 0.001 for all). Sensitivity of individual signs was low (< 20%) but specificity high (98-100%). If any one of oral thrush, hepatomegaly, splenomegaly, lymphadenopathy, diaper dermatitis, weight < 50(th) centile are present, sensitivity for HIV infection amongst HIV-exposed infants was 86%. These algorithms performed similarly when used to predict severe immune suppression.

CONCLUSIONS

A combination of physical findings is helpful in identifying infants most likely to be HIV-infected. This may inform management algorithms and provide guidance for focused laboratory testing in some settings, and should be further validated in these settings and elsewhere.

摘要

背景

由于感染 HIV 的婴儿死亡率较高，世界卫生组织现在建议在婴儿生命的第一年尽早开始抗逆转录病毒治疗。然而，在许多情况下，实验室诊断婴儿 HIV 并不容易。我们旨在使用南非儿童 HIV 早期抗逆转录病毒治疗（CHER）研究的筛查数据，为<10 周龄的婴儿开发一种 HIV 疑似诊断的临床算法。

通过垂直传播预防计划确定了<10 周龄的 HIV 感染和未感染的暴露婴儿。系统地记录了临床和实验室数据，使用 Kruskal-Wallis 检验、方差分析（ANOVA）和 Fisher 精确检验比较了组间差异。使用临床发现的组合编制了受试者工作特征（ROC）曲线。

结果

共纳入 417 名 HIV 感染和 125 名 HIV 暴露、未感染的婴儿，中位年龄为 46 天（IQR 38-55）。HIV 感染婴儿的 CD4 百分比中位数为 34（IQR 28-41）%。与未感染的 HIV 暴露婴儿相比，HIV 感染婴儿的体重与年龄比、淋巴结肿大、口腔鹅口疮和肝肿大的比例更低（调整后的优势比分别为 0.51、8.8、5.6 和 23.5；所有 p<0.001）。个别体征的敏感性较低（<20%），但特异性较高（98-100%）。如果存在口腔鹅口疮、肝肿大、脾肿大、淋巴结肿大、尿布性皮炎、体重<第 50 百分位数中的任何一种，HIV 暴露婴儿中 HIV 感染的敏感性为 86%。当用于预测严重免疫抑制时，这些算法的性能相似。