O'Hare Bernadette, Milner Danny A, Newberry Laura, Pelani Isaac, Malisita Ken
University of St Andrews and College of Medicine, Private Bag 360, Chichiri, Blantyre, Malawi.
BMC Res Notes. 2014 Sep 22;7:666. doi: 10.1186/1756-0500-7-666.
Since May 2014, all HIV positive children aged less than five years in Malawi are eligible for ART. For children older than five years they are eligible if they are in WHO stage III/IV, if stage I/II, if their CD4 < 500 cells/mm3. Our goal was to compare the WHO clinical classification criteria (WHO stage + CD4/age) to CD4 count (CD4/age) on all children. Prior to 2014, children aged 2-5 years in stage I and II were eligible for ART if their CD4 was < 750 cells/mm3. We were interested in the increase in numbers of children in this age group who now meet the eligibility criteria and their average CD4 count.
Data including age, stage and CD4 count were used. We examined the effect of using two different criteria; WHO staging and checking CD4 count if stage I or II versus CD4 count on all, on the numbers of children eligibility for ART in a cohort of 969 children aged 0 to 14 years in Blantyre, Malawi.
Using WHO stage + CD4/age, 786 patients out of 969 would have been treated and 183 would not. Using CD4/age, 745 patients out of 969 would have been treated and 224 would not. Within the 224 patients not treated by CD4 classification, 41 were clinical stage III or IV. The most common staging condition in these 41 children was low weight for age (i.e. underweight). 41% of children age2-5 years have a CD4 count >750.
Most children are correctly started on treatment using recent guidelines. 41% more children <5 years will be started on ART.
自2014年5月起，马拉维所有年龄小于5岁的HIV阳性儿童均有资格接受抗逆转录病毒治疗（ART）。对于年龄大于5岁的儿童，如果处于世界卫生组织（WHO）III/IV期，或者处于I/II期且CD4细胞计数<500个/mm³，则有资格接受治疗。我们的目标是比较WHO临床分类标准（WHO分期+CD4/年龄）与所有儿童的CD4细胞计数（CD4/年龄）。在2014年之前，处于I期和II期的2至5岁儿童，如果其CD4细胞计数<750个/mm³，则有资格接受ART治疗。我们感兴趣的是这个年龄组中现在符合资格标准的儿童数量的增加情况及其平均CD4细胞计数。
使用包括年龄、分期和CD4细胞计数在内的数据。我们研究了使用两种不同标准的效果；WHO分期以及对于I期或II期检查CD4细胞计数与对所有儿童检查CD4细胞计数，对马拉维布兰太尔969名0至14岁儿童队列中符合ART治疗资格的儿童数量的影响。
使用WHO分期+CD4/年龄，969名患者中有786名会接受治疗，183名不会接受治疗。使用CD4/年龄，969名患者中有745名会接受治疗，224名不会接受治疗。在未通过CD4分类接受治疗的224名患者中，41名是临床III期或IV期。这41名儿童中最常见的分期情况是年龄别体重低（即体重不足）。41%的2至5岁儿童CD4细胞计数>750。
大多数儿童根据最新指南正确开始接受治疗。<5岁的儿童接受ART治疗的人数将增加41%。
