接受联合抗逆转录病毒治疗的HIV-1感染儿童不良结局的预测因素：撒哈拉以南非洲地区一个DREAM队列的研究结果
Predictors of adverse outcomes in HIV-1-infected children receiving combination antiretroviral treatment: results from a DREAM cohort in sub-Saharan Africa.
作者信息
Marazzi Maria Cristina, De Luca Simona, Palombi Leonardo, Scarcella Paola, Ciccacci Fausto, Ceffa Susanna, Nielsen-Saines Karin, De Luca Andrea, Mancinelli Sandro, Gennaro Elisabetta, Zimba Ines, Liotta Giuseppe, Buonomo Ersilia
机构信息
From the *Department of Preventive Medicine, LUMSA University (Libera Università Maria SS. Assunta); †DREAM Program; ‡Department of Biomedicine and Prevention, Tor Vergata University, via Montpellier, Rome, Italy; §Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA; ¶Azienda Ospedaliedra Universitaria Senese, Siena; ‖Università Cattolica Sacro Cuore, Rome, Italy; and **DREAM Program Mozambique, Maputo, Mozambique.
出版信息
Pediatr Infect Dis J. 2014 Mar;33(3):295-300. doi: 10.1097/INF.0b013e3182a0994b.
BACKGROUND
HIV-infected children have less access to combination antiretroviral therapy as compared with adults in resource-limited settings. Growth faltering, loss to follow-up (LTFU) and high mortality are frequently seen.
METHODS
A retrospective cohort study was performed with parameters extracted from the Drug Resource Enhancement against AIDS and Malnutrition database for HIV-infected, antiretroviral naïve children under 15 years presenting for care at 17 Drug Resource Enhancement against AIDS and Malnutrition centers in Mozambique, Malawi and Guinea between January 2005 to December 2008. Predictors of time-to-death, time-to-LTFU and persistence of malnutrition by Cox's regression and Kaplan-Meier were determined.
RESULTS
2215 children presented to care with 1343 (61%) being ≤ 5 years. At baseline, stunting and malnutrition occurred in 40% and 25%, respectively; 75% of 2149 children had CD4 cell percentages less than 20; median HIV RNA, log10 cp/mL, was 4.97 in 1927 patients. Over time 238 children died (10.7%; 2.7% person-years [PY]) 63 were LTFU (2.8%; 0.7% PY). By multivariate analysis, mortality was associated with virus load (hazards ratio: 1.19; confidence interval: 1.01-1.402, P = 0.038) and reduced weight-for-age Z scores (hazards ratio: 0.590; confidence interval: 0.53-0.66, P < 0.001). LTFU was associated with low weight-for-height Z scores (hazards ratio: 0.71; confidence interval: 0.51-0.97, P = 0.031). At 12 months after combination antiretroviral therapy, anthropometric parameters significantly improved in 1226 children (P < 0.001); virus load declined to <400 copies/mL in over 60%.
CONCLUSIONS
Despite advanced HIV disease, children initiating combination antiretroviral therapy had mortality rates of 2.7% p/PY with overall attrition rates of 11.7% p/100 PY, with significant reversal of negative anthropometric markers, and improvement of immunological and virological parameters in children with 12 months of follow-up.
背景
在资源有限的环境中，与成人相比，感染艾滋病毒的儿童获得联合抗逆转录病毒疗法的机会更少。生长发育迟缓、失访和高死亡率屡见不鲜。
方法
进行了一项回顾性队列研究，从抗艾滋病和营养不良药物资源增强数据库中提取参数，该数据库涵盖了2005年1月至2008年12月期间在莫桑比克、马拉维和几内亚的17个抗艾滋病和营养不良药物资源增强中心接受治疗的15岁以下未接受过抗逆转录病毒治疗的艾滋病毒感染儿童。通过Cox回归和Kaplan-Meier方法确定死亡时间、失访时间和营养不良持续时间的预测因素。
结果
2215名儿童前来就诊，其中1343名（61%）年龄≤5岁。基线时，发育迟缓率和营养不良率分别为40%和25%；2149名儿童中有75%的CD4细胞百分比低于20；1927名患者的艾滋病毒RNA中位数（log10 cp/mL）为4.97。随着时间的推移，238名儿童死亡（10.7%；2.7%人年[PY]），63名失访（2.8%；0.7% PY）。多变量分析显示，死亡率与病毒载量相关（风险比：1.19；置信区间：1.01 - 1.402，P = 0.038）以及年龄别体重Z评分降低（风险比：0.590；置信区间：0.53 - 0.66，P < 0.001）。失访与身高别体重Z评分低相关（风险比：0.71；置信区间：0.51 - 0.97，P = 0.031）。在接受联合抗逆转录病毒治疗12个月后，1226名儿童的人体测量参数显著改善（P < 0.001）；超过60%的儿童病毒载量降至<400拷贝/mL。
结论
尽管艾滋病毒疾病处于晚期，但开始接受联合抗逆转录病毒治疗的儿童死亡率为2.7% p/PY，总损耗率为11.7% p/100 PY，负面人体测量指标显著逆转，且随访12个月的儿童免疫和病毒学参数得到改善。
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