Koller Manuel, Patel Kunjal, Chi Benjamin H, Wools-Kaloustian Kara, Dicko Fatoumata, Chokephaibulkit Kulkanya, Chimbetete Cleophas, Avila Dorita, Hazra Rohan, Ayaya Samual, Leroy Valeriane, Truong Huu Khanh, Egger Matthias, Davies Mary-Ann
*Institute of Social & Preventive Medicine (ISPM), University of Bern, Bern, Switzerland; †Department of Epidemiology, Harvard School of Public Health, Boston, MA; ‡Centre for Infectious Disease Research in Zambia, Lusaka, Zambia; §Department of Medicine, Indiana University School of Medicine, Indianapolis, IN; ‖Department of Pediatrics, Gabriel Toure Hospital, Bamako, Mali; ¶Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand; #Newlands Clinic, Harare, Zimbabwe; **Maternal and Pediatric Infectious Disease Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), Bethesda, MD; ††Department of Pediatrics, College of Health Sciences, Moi University, Kenya; ‡‡INSERM, French National Institute for Health and Medical Research, U897, Bordeaux, France; §§Children's Hospital 1, Ho Chi Minh City, Vietnam; and ‖‖School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
J Acquir Immune Defic Syndr. 2015 Jan 1;68(1):62-72. doi: 10.1097/QAI.0000000000000380.
The CD4 cell count or percent (CD4%) at the start of combination antiretroviral therapy (cART) is an important prognostic factor in children starting therapy and an important indicator of program performance. We describe trends and determinants of CD4 measures at cART initiation in children from low-, middle-, and high-income countries.
We included children aged <16 years from clinics participating in a collaborative study spanning sub-Saharan Africa, Asia, Latin America, and the United States. Missing CD4 values at cART start were estimated through multiple imputation. Severe immunodeficiency was defined according to World Health Organization criteria. Analyses used generalized additive mixed models adjusted for age, country, and calendar year.
A total of 34,706 children from 9 low-income, 6 lower middle-income, 4 upper middle-income countries, and 1 high-income country (United States) were included; 20,624 children (59%) had severe immunodeficiency. In low-income countries, the estimated prevalence of children starting cART with severe immunodeficiency declined from 76% in 2004 to 63% in 2010. Corresponding figures for lower middle-income countries were from 77% to 66% and for upper middle-income countries from 75% to 58%. In the United States, the percentage decreased from 42% to 19% during the period 1996 to 2006. In low- and middle-income countries, infants and children aged 12-15 years had the highest prevalence of severe immunodeficiency at cART initiation.
Despite progress in most low- and middle-income countries, many children continue to start cART with severe immunodeficiency. Early diagnosis and treatment of HIV-infected children to prevent morbidity and mortality associated with immunodeficiency must remain a global public health priority.
在开始联合抗逆转录病毒治疗（cART）时的CD4细胞计数或百分比（CD4%）是开始治疗的儿童的一个重要预后因素，也是项目绩效的一个重要指标。我们描述了来自低收入、中等收入和高收入国家的儿童在开始cART时CD4检测指标的趋势和决定因素。
我们纳入了来自参与一项横跨撒哈拉以南非洲、亚洲、拉丁美洲和美国的合作研究的诊所的16岁以下儿童。通过多重填补法估计cART开始时缺失的CD4值。根据世界卫生组织标准定义严重免疫缺陷。分析采用了针对年龄、国家和日历年进行调整的广义相加混合模型。
共纳入了来自9个低收入国家、6个中低收入国家、4个中高收入国家和1个高收入国家（美国）的34706名儿童；20624名儿童（59%）有严重免疫缺陷。在低收入国家，开始cART时伴有严重免疫缺陷的儿童的估计患病率从2004年的76%降至2010年的63%。中低收入国家的相应数字从77%降至66%，中高收入国家从75%降至58%。在美国，1996年至2006年期间这一百分比从42%降至19%。在低收入和中等收入国家，婴儿和12 - 15岁的儿童在开始cART时严重免疫缺陷的患病率最高。
尽管大多数低收入和中等收入国家取得了进展，但许多儿童在开始cART时仍有严重免疫缺陷。对感染HIV的儿童进行早期诊断和治疗以预防与免疫缺陷相关的发病和死亡，仍必须是全球公共卫生的优先事项。
