Innes Steve, Lazarus Erica, Otwombe Kennedy, Liberty Afaaf, Germanus Ramona, Van Rensburg Anita Janse, Grobbelaar Nelis, Hurter Theunis, Eley Brian, Violari Avy, Cotton Mark F
Children's Infectious Diseases Clinical Research Unit (KID-CRU), Stellenbosch University and Tygerberg Children's Hospital, Cape Town, South Africa;
Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg and Chris Hani Baragwanath Hospital, Soweto, South Africa.
J Int AIDS Soc. 2014 Jun 11;17(1):18914. doi: 10.7448/IAS.17.1.18914. eCollection 2014.
To describe the degree of HIV disease progression in infants initiating antiretroviral therapy (ART) by three months of age in a programmatic setting in South Africa.
This was a programmatic cohort study.
Electronic and manual data extraction from databases and antiretroviral registers in 20 public clinics in Cape Town and electronic data extraction from a large ART service at Chris Hani Baragwanath Hospital in Soweto were performed. Records of all infants initiated on ART by three months of age between June 2007 and September 2010 were extracted. Demographics, immunological and clinical stage at ART initiation were analyzed descriptively by chi-square, two-sample t-test and Kaplan-Meier methods.
A total of 403 records were identified: 88 in Cape Town and 315 in Soweto. Median age at ART initiation was 8.4 [interquartile range (IQR): 7.2-9.7] weeks. At ART initiation, 250 infants (62%) had advanced HIV disease (CD4% <25% or absolute CD4<1500 cells/mm(3) or WHO clinical Stage 3 or 4). Median age at ART initiation by site was 10.3 (IQR: 8.2-11.9) weeks in Cape Town and 8.6 (IQR: 7.7-10.0) weeks in Soweto infants (p<0.0001). In Cape Town, 73 infants (83%) had advanced HIV disease at ART initiation, compared to 177 infants (56%) in Soweto (p<0.0001). On logistic regression, each month increase in age at ART initiation lowered the odds of initiating ART in an optimal state (OR: 0.56, CI: 0.36-0.94) and increased the odds of advanced HIV disease at ART initiation (OR: 1.69, CI: 1.05-2.71).
ART initiation by three months of age may not adequately prevent disease progression. New emphasis on early diagnosis and rapid initiation of ART in the first weeks of life are essential to further reduce infant mortality.
描述在南非的一个项目环境中，三个月大时开始接受抗逆转录病毒治疗（ART）的婴儿的HIV疾病进展程度。
这是一项项目队列研究。
从开普敦20家公共诊所的数据库和抗逆转录病毒登记册中进行电子和人工数据提取，并从索韦托的克里斯·哈尼·巴拉格瓦纳特医院的一项大型ART服务中进行电子数据提取。提取了2007年6月至2010年9月期间所有三个月大时开始接受ART治疗的婴儿的记录。通过卡方检验、双样本t检验和Kaplan-Meier方法对ART开始时的人口统计学、免疫学和临床分期进行描述性分析。
共识别出403条记录：开普敦88条，索韦托315条。开始接受ART治疗的中位年龄为8.4周[四分位间距（IQR）：7.2 - 9.7周]。在开始接受ART治疗时，250名婴儿（62%）患有晚期HIV疾病（CD4%<25%或绝对CD4<1500个细胞/mm³或世界卫生组织临床分期3或4期）。按地点划分，开普敦开始接受ART治疗的婴儿中位年龄为10.3周（IQR：8.2 - 11.9周），索韦托婴儿为8.6周（IQR：7.7 - 10.0周）（p<0.0001）。在开普敦，73名婴儿（83%）在开始接受ART治疗时患有晚期HIV疾病，而索韦托为177名婴儿（56%）（p<0.0001）。逻辑回归分析显示，开始接受ART治疗时年龄每增加一个月，在最佳状态下开始接受ART治疗的几率降低（比值比：0.56，置信区间：0.36 - 0.94），且在开始接受ART治疗时患有晚期HIV疾病的几率增加（比值比：1.69，置信区间：1.05 - 2.71）。
三个月大时开始接受ART治疗可能无法充分预防疾病进展。重新强调在生命的最初几周进行早期诊断和快速开始ART治疗对于进一步降低婴儿死亡率至关重要。
