Agwu Allison L, Fleishman John A, Rutstein Richard, Korthuis P Todd, Gebo Kelly
Division of Pediatric Infectious Diseases, Department of Pediatrics, and Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, and
Center for Financing, Access, and Cost Trends, Agency for Health Care Research and Quality, Rockville, Maryland.
J Pediatric Infect Dis Soc. 2013 Sep;2(3):215-23. doi: 10.1093/jpids/pit008. Epub 2013 Mar 12.
Due to successful antiretroviral therapy (ART), perinatally human immunodeficiency virus (PHIV)-infected children are reaching adolescence and young adulthood. Adolescence is characterized by factors (eg, increased risk-taking) that may hamper management. We examined PHIV-infected youth in a multisite US cohort, assessing factors associated with changes in advanced immunosuppression and detectable viremia over time.
We conducted a retrospective study of 521 PHIV-infected youth, 12 years and older, followed at 16 HIV clinics in the HIV Research Network between 2002 and 2010. We assessed demographic and clinical factors associated with CD4 <200 cells/mm(3) and viral load ≥2.60 log10 HIV-1 RNA copies/mL using multivariable logistic regression.
Between 2002 and 2010, the median age of PHIV-infected youth in care increased from 14 to 18 years. The proportion prescribed ART increased from 67.4% to 84%, with virologic suppression increasing from 35.5% to 63.0% (P trend < .01). Older age, Black and Hispanic race/ethnicity, and increasing viremia were independently associated with CD4 <200 cells/mm(3). Older age, Black race and Hispanic ethnicity were independently associated with higher likelihood of detectable viremia, whereas more recent year of evaluation and being prescribed ART were associated with a lower likelihood.
The proportion of PHIV-infected youth on ART has increased. Rates of viremia and advanced immunosuppression have decreased in recent years, but both rates are higher for older PHIV-infected youth. Factors associated with advanced immunosuppression and viremia offer the chance to define strategies to optimize outcomes.
由于抗逆转录病毒疗法（ART）取得成功，围产期感染人类免疫缺陷病毒（PHIV）的儿童正步入青春期和青年期。青春期具有一些可能妨碍管理的因素（例如，冒险行为增加）。我们在美国一个多中心队列中对感染PHIV的青年进行了研究，评估了与晚期免疫抑制变化以及随时间推移可检测到病毒血症相关的因素。
我们对2002年至2010年间在HIV研究网络的16家HIV诊所随访的521名12岁及以上感染PHIV的青年进行了一项回顾性研究。我们使用多变量逻辑回归评估了与CD4<200个细胞/mm³和病毒载量≥2.60 log10 HIV-1 RNA拷贝/mL相关的人口统计学和临床因素。
在2002年至2010年间，接受治疗的感染PHIV青年的中位年龄从14岁增加到18岁。接受ART治疗的比例从67.4%增加到84%，病毒学抑制率从35.5%增加到63.0%（P趋势<.01）。年龄较大、黑人及西班牙裔种族/族裔以及病毒血症增加与CD4<200个细胞/mm³独立相关。年龄较大、黑人种族和西班牙裔族裔与可检测到病毒血症的较高可能性独立相关，而更近的评估年份和接受ART治疗则与较低可能性相关。
接受ART治疗的感染PHIV青年比例有所增加。近年来病毒血症和晚期免疫抑制率有所下降，但对于年龄较大的感染PHIV青年，这两种率都更高。与晚期免疫抑制和病毒血症相关的因素为确定优化治疗结果的策略提供了机会。
