B-Lajoie Marie-Renée, Drouin Olivier, Bartlett Gillian, Nguyen Quynh, Low Andrea, Gavriilidis Georgios, Easterbrook Philippa, Muhe Lulu
Department of Family Medicine.
Department of Paediatrics, McGill University, Montreal, Canada.
Clin Infect Dis. 2016 Jun 15;62(12):1586-1594. doi: 10.1093/cid/ciw139. Epub 2016 Mar 21.
We conducted a systematic review and meta-analysis to evaluate the incidence and prevalence of 14 opportunistic infections (OIs) and other infections as well as the impact of antiretroviral therapy (ART) among human immunodeficiency virus (HIV)-infected children (aged <18 years) in low- and middle-income countries (LMICs), to understand regional burden of disease, and inform delivery of HIV services.
Eligible studies described the incidence of OIs and other infections in ART-naive and -exposed children from January 1990 to November 2013, using Medline, Global Health, Embase, Cumulative Index to Nursing and Allied Health Literature, Web of Knowledge, and Literatura Latino Americana em Ciências da Saúde databases. Summary incident risk (IR) and prevalent risk for each OI in ART-naive and ART-exposed children were calculated, and unadjusted odds ratios calculated for impact of ART. The number of OI cases and associated costs averted were estimated using the AIDS impact model.
We identified 4542 citations, and 88 studies were included, comprising 55 679 HIV-infected children. Bacterial pneumonia and tuberculosis were the most common incident and prevalent infections in both ART-naive and ART-exposed children. There was a significant reduction in IR with ART for the majority of OIs. There was a smaller impact on bacterial sepsis and pneumonia, and an increase observed for varicella zoster. ART initiation based on 2010 World Health Organization guidelines criteria for ART initiation in children was estimated to potentially avert >161 000 OIs (2013 UNAIDS data) with estimated cost savings of at least US$17 million per year.
There is a decrease in the risk of most OIs with ART use in HIV-infected children in LMICs, and estimated large potential cost savings in OIs averted with ART use, although there are greater uncertainties in pediatric data compared with that of adults.
我们进行了一项系统评价和荟萃分析，以评估低收入和中等收入国家（LMICs）中14种机会性感染（OIs）和其他感染在感染人类免疫缺陷病毒（HIV）的儿童（年龄<18岁）中的发病率和患病率，以及抗逆转录病毒疗法（ART）的影响，从而了解疾病的区域负担，并为HIV服务的提供提供信息。
符合条件的研究描述了1990年1月至2013年11月期间未接受ART治疗和接受ART治疗的儿童中OIs和其他感染的发病率，使用了Medline、全球卫生、Embase、护理学与健康相关文献累积索引、知识网络和拉丁美洲健康科学文献数据库。计算了未接受ART治疗和接受ART治疗的儿童中每种OI的汇总发病风险（IR）和流行风险，并计算了ART影响的未调整比值比。使用艾滋病影响模型估计了OI病例数和避免的相关成本。
我们识别出4542条引文，纳入了88项研究，包括55679名感染HIV的儿童。细菌性肺炎和结核病是未接受ART治疗和接受ART治疗的儿童中最常见的发病和流行感染。对于大多数OIs，ART治疗使IR显著降低。对细菌性败血症和肺炎的影响较小，而水痘带状疱疹的发病率有所增加。根据2010年世界卫生组织儿童ART启动指南标准启动ART，估计每年可避免超过16.1万例OIs（2013年联合国艾滋病规划署数据），估计每年至少节省成本1700万美元。
在LMICs中，HIV感染儿童使用ART可降低大多数OIs的风险，并且估计使用ART可避免大量潜在的OI成本节省，尽管与成人数据相比，儿科数据存在更大的不确定性。
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