Ciaranello Andrea, Lu Zhigang, Ayaya Samuel, Losina Elena, Musick Beverly, Vreeman Rachel, Freedberg Kenneth A, Abrams Elaine J, Dillabaugh Lisa, Doherty Katie, Ssali John, Yiannoutsos Constantin T, Wools-Kaloustian Kara
From the *Division of Infectious Diseases and Medical Practice Evaluation Center; †Division of General Medicine and Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA; ‡Department of Child Health and Paediatrics, Moi University School of Medicine, Eldoret, Kenya; §Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA; ¶Department of Biostatistics, Indiana University; ‖Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN; **ICAP, Mailman School of Public Health, Columbia University and College of Physicians and Surgeons, Columbia University, NY; ††Family AIDS Care and Education Service (FACES) program, Kisumu, Kenya; ‡‡Department of Pediatrics, University of California, San Francisco, CA; §§Masaka Regional Referral Hospital, AHF-Uganda Cares Masaka, Uganda; and ¶¶Division of Infectious Disease, Indiana University School of Medicine, Indianapolis, IN.
Pediatr Infect Dis J. 2014 Jun;33(6):623-9. doi: 10.1097/INF.0000000000000223.
Few studies have reported CD4%- and age-stratified rates of World Health Organization Stage 3 (WHO3) events, World Health Organization Stage 4 (WHO4) events, tuberculosis (TB) and mortality in HIV-infected infants before initiation of antiretroviral therapy.
HIV-infected children enrolled before 1 year of age in the International Epidemiologic Databases to Evaluate AIDS East Africa region (October 1, 2002, to November, 2008) were included. We estimated incidence rates of earliest clinical event (WHO3, WHO4 and TB), before antiretroviral therapy initiation per local guidelines, stratified by current age (< or ≥6 months) and current CD4% (<15%, 15-24%, ≥25%). CD4%-stratified mortality rates were estimated separately for children who did not experience a clinical event ("background" mortality) and for children who experienced an event, including "acute" mortality (≤30 days post event) and "later" mortality (>30 days post event).
Among 847 children (median enrollment age: 4.8 months; median pre-antiretroviral therapy follow up: 10.8 months; 603 (71%) with ≥1 CD4% recorded), event rates were comparable for those aged <6 and ≥6 months. Current CD4% was associated with risk of WHO4 events for children <6 months of age and with all evaluated events for children ≥6 months old (P < 0.05). "Background" mortality was 3.7-8.4/100 person-years (PY). "Acute" mortality (≤30 days post event) was 33.8/100 PY (after TB) and 41.1/100 PY (after WHO3 or WHO4). "Later" mortality (>30 days post event) ranged by CD4% from 4.7 to 29.1/100 PY.
In treatment-naïve, HIV-infected infants, WHO3, WHO4 and TB events were common before and after 6 months of age and led to substantial increases in mortality. Early infant HIV diagnosis and treatment are critically important, regardless of CD4%.
很少有研究报告在开始抗逆转录病毒治疗之前，按CD4%和年龄分层的世界卫生组织3期（WHO3）事件、世界卫生组织4期（WHO4）事件、结核病（TB）以及HIV感染婴儿的死亡率。
纳入在东非地区国际评估艾滋病流行病学数据库（2002年10月1日至2008年11月）中1岁前入组的HIV感染儿童。我们根据当地指南，在开始抗逆转录病毒治疗之前，估计最早临床事件（WHO3、WHO4和TB）的发病率，按当前年龄（<或≥6个月）和当前CD4%（<15%、15 - 24%、≥25%）分层。分别针对未经历临床事件的儿童（“背景”死亡率）以及经历事件的儿童估计CD4%分层的死亡率，包括“急性”死亡率（事件发生后≤30天）和“后期”死亡率（事件发生后>30天）。
在847名儿童中（中位入组年龄：4.8个月；抗逆转录病毒治疗前中位随访时间：10.8个月；603名（71%）记录有≥1次CD4%），年龄<6个月和≥6个月的儿童事件发生率相当。当前CD4%与<6个月龄儿童发生WHO4事件的风险以及≥6个月龄儿童所有评估事件的风险相关（P<0.05）。“背景”死亡率为3.7 - 8.4/100人年（PY）。“急性”死亡率（事件发生后≤30天）为33.8/100 PY（结核病后）和41.1/100 PY（WHO3或WHO4后）。“后期”死亡率（事件发生后>30天）按CD4%范围为4.7至29.1/100 PY。
在未经治疗的HIV感染婴儿中，WHO3、WHO4和TB事件在6个月龄前后都很常见，并导致死亡率大幅上升。无论CD4%如何，早期婴儿HIV诊断和治疗都至关重要。
