HIV-NAT, The Thai Red Cross AIDS Research Centre, Bangkok, Thailand.
Pediatr Infect Dis J. 2013 May;32(5):501-8. doi: 10.1097/INF.0b013e31827fb19d.
We previously reported similar AIDS-free survival at 3 years in children who were >1 year old initiating antiretroviral therapy (ART) and randomized to early versus deferred ART in the Pediatric Randomized to Early versus Deferred Initiation in Cambodia and Thailand (PREDICT) study. We now report neurodevelopmental outcomes.
Two hundred eighty-four HIV-infected Thai and Cambodian children aged 1-12 years with CD4 counts between 15% and 24% and no AIDS-defining illness were randomized to initiate ART at enrollment ("early," n = 139) or when CD4 count became <15% or a Centers for Disease Control (CDC) category C event developed ("deferred," n = 145). All underwent age-appropriate neurodevelopment testing including Beery Visual Motor Integration, Purdue Pegboard, Color Trails and Child Behavioral Checklist. Thai children (n = 170) also completed Wechsler Intelligence Scale (intelligence quotient) and Stanford Binet Memory test. We compared week 144 measures by randomized group and to HIV-uninfected children (n = 319).
At week 144, the median age was 9 years and 69 (48%) of the deferred arm children had initiated ART. The early arm had a higher CD4 (33% versus 24%, P < 0.001) and a greater percentage of children with viral suppression (91% versus 40%, P < 0.001). Neurodevelopmental scores did not differ by arm, and there were no differences in changes between arms across repeated assessments in time-varying multivariate models. HIV-infected children performed worse than uninfected children on intelligence quotient, Beery Visual Motor Integration, Binet memory and Child Behavioral Checklist.
In HIV-infected children surviving beyond 1 year of age without ART, neurodevelopmental outcomes were similar with ART initiation at CD4 15%-24% versus <15%, but both groups performed worse than HIV-uninfected children. The window of opportunity for a positive effect of ART initiation on neurodevelopment may remain in infancy.
我们之前报道过，在年龄大于 1 岁且开始接受抗逆转录病毒治疗（ART）的儿童中，在柬埔寨和泰国儿童早期与延迟 ART 随机分组（PREDICT）研究中，早期与延迟 ART 治疗组在 3 年内艾滋病无进展生存率相似。我们现在报告神经发育结局。
284 名年龄在 1-12 岁之间、CD4 计数在 15%-24%之间且无艾滋病定义性疾病的感染 HIV 的泰国和柬埔寨儿童被随机分为在入组时开始 ART（早期组，n=139）或当 CD4 计数降至<15%或出现美国疾病控制与预防中心（CDC）C 类事件时开始 ART（延迟组，n=145）。所有儿童均接受适合年龄的神经发育测试，包括 Beery 视觉运动综合测验、Purdue 钉板测验、颜色轨迹测试和儿童行为检查表。泰国儿童（n=170）还完成了韦氏智力测验和斯坦福-比奈记忆测验。我们比较了随机分组儿童在第 144 周的测量值，并与未感染 HIV 的儿童（n=319）进行了比较。
第 144 周时，中位年龄为 9 岁，69 名（48%）延迟组儿童已开始接受 ART。早期组 CD4 更高（33%比 24%，P<0.001），病毒抑制率更高（91%比 40%，P<0.001）。神经发育评分在组间无差异，且在时间变化的多变量模型中，两组间的变化在重复评估中无差异。感染 HIV 的儿童在智商、Beery 视觉运动综合测验、Binet 记忆和儿童行为检查表方面的表现均不如未感染的儿童。
在未接受 ART 而存活 1 年以上的感染 HIV 的儿童中，在 CD4 计数为 15%-24%时开始 ART 与<15%时开始 ART 的神经发育结局相似，但两组的表现均不如未感染 HIV 的儿童。ART 启动对神经发育产生积极影响的窗口期可能仍在婴儿期。
