From the *Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University; †HIV Netherlands Australia Thailand Research Collaboration (HIV-NAT), Thai Red Cross-AIDS Research Centre, Bangkok, Thailand; ‡Biostatistics and Databases Program, The Kirby Institute, Faculty of Medicine, The University of New South Wales, Sydney, Australia; §Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok; ¶Department of Pediatrics, Khon Kaen University, Khon Kaen; ‖Department of Pediatrics, Chiangrai Prachanukroh Hospital, Chiang Rai, Thailand; **Department of Pediatrics, Hospital Likas, Kota Kinabalu, Malaysia; ††YR Gaitonde Centre for AIDS Research and Education, Chennai, India; ‡‡Pediatric Institute, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia; §§Chiang Mai University, Chiang Mai; and ¶¶TREAT Asia/amfAR-The Foundation for AIDS Research, Bangkok, Thailand.
Pediatr Infect Dis J. 2014 Jul;33(7):747-52. doi: 10.1097/INF.0000000000000226.
There are limited data on opportunistic infections (OIs) and factors associated with their occurrence after highly active antiretroviral therapy (HAART) in Asian children. The use of HAART in Asia started much later than in developed countries and therefore reported findings may not be fully applicable to the pediatric HIV epidemic in Asia.
Retrospective and prospectively collected data from the Therapeutic Research, Education and AIDS Training Asia Pediatric HIV Observational Database cohort study from March 1993 to March 2009 were analyzed. OIs were defined according to World Health Organization clinical staging criteria and incidence rates calculated. Factors associated with the incidence of severe OIs were analyzed using random effects Poisson regression modeling.
Of 2280 children in the cohort, 1752 were ever reported to have received antiretroviral therapy, of whom 1480 (84%) started on HAART. Before commencing any antiretroviral therapy, OIs occurred at a rate of 89.5 per 100 person-years. The incidence rate was 28.8 infections per 100 person-years during mono- or dual-therapy and 10.5 infections per 100 person-years during HAART. The most common OIs both before and after antiretroviral therapy initiation were recurrent upper respiratory tract infections, persistent oral candidiasis and pulmonary tuberculosis. The incidence rates of World Health Organization clinical stage 3 or 4 OIs after HAART were highest among children <18 months of age and those with low weight-for-age z scores, CD4 cell % <15%, and World Health Organization stage 3 at HAART initiation.
Despite dramatic declines in their incidence, OIs remained important causes of morbidity after HAART initiation in this regional cohort of HIV-infected children in Asia.
在亚洲，接受高效抗逆转录病毒治疗（HAART）后发生机会性感染（OIs）及其相关因素的数据有限。亚洲开始使用 HAART 的时间比发达国家晚得多，因此报告的结果可能不完全适用于亚洲儿童中的 HIV 流行。
对 1993 年 3 月至 2009 年 3 月间治疗研究、教育和艾滋病培训亚洲儿科 HIV 观察数据库队列研究中回顾性和前瞻性收集的数据进行分析。根据世界卫生组织临床分期标准定义 OIs，并计算发病率。采用随机效应泊松回归模型分析与严重 OIs 发病相关的因素。
队列中 2280 例儿童中，1752 例曾接受过抗逆转录病毒治疗，其中 1480 例（84%）开始接受 HAART。在开始任何抗逆转录病毒治疗之前，OIs 的发生率为每 100 人年 89.5 例。在单药或双药治疗期间，发病率为每 100 人年 28.8 例感染，在 HAART 期间，发病率为每 100 人年 10.5 例感染。开始抗逆转录病毒治疗前后最常见的 OIs 均为复发性上呼吸道感染、持续性口腔念珠菌病和肺结核。在 HAART 后，年龄<18 个月和体重不足年龄 Z 评分低、HAART 开始时 CD4 细胞百分比<15%和世界卫生组织分期 3 期的儿童中，世界卫生组织临床分期 3 或 4 期 OIs 的发病率最高。
尽管发病率显著下降，但在亚洲这一 HIV 感染儿童的区域队列中，HAART 后 OIs 仍然是发病率的重要原因。
