Ásbjörnsdóttir Kristjana H, Hughes James P, Wamalwa Dalton, Langat Agnes, Slyker Jennifer A, Okinyi Hellen M, Overbaugh Julie, Benki-Nugent Sarah, Tapia Kenneth, Maleche-Obimbo Elizabeth, Rowhani-Rahbar Ali, John-Stewart Grace
aDepartment of Epidemiology bDepartment of Biostatistics, University of Washington, Seattle, Washington, USA cDepartment of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya dDepartment of Global Health eDepartment of Microbiology, University of Washington fHuman Biology Division, Fred Hutchinson Cancer Research Center gCenter for AIDS Research Biostatistics Core hDepartment of Medicine iDepartment of Pediatrics, University of Washington, Seattle, Washington, USA.
AIDS. 2016 Nov 28;30(18):2835-2843. doi: 10.1097/QAD.0000000000001244.
Virologic and immunologic responses to antiretroviral treatment (ART) in infants may differ from older children due to immunologic, clinical, or epidemiologic characteristics.
Longitudinal ART responses were modeled and compared in HIV-infected infants and children enrolled in cohorts in Nairobi, Kenya. Participants were enrolled soon after HIV diagnosis, started on ART, and followed for 2 years. Viral load decline was compared between infant and child cohorts using a nonlinear mixed effects model and CD4% reconstitution using a linear mixed effects model.
Among 121 infants, median age at ART was 3.9 months; among 124 children, median age was 4.8 years. At baseline, viral load was higher among infants than children (6.47 vs. 5.91 log10 copies/ml, P < 0.001). Infants were less likely than children to suppress viral load to less than 250 copies/ml following 6 months of ART (32% infants vs. 73% children, P < 0.0001). CD4% was higher at baseline in infants than children (19 vs. 7.3%, P < 0.001). Older children had more rapid CD4% reconstitution than infants, but failed to catch up to infant CD4%.
Despite substantially higher CD4% at ART initiation, viral suppression was significantly slower among infants than older children. New strategies are needed to optimize infant outcomes on ART.
由于免疫、临床或流行病学特征，婴儿对抗逆转录病毒治疗（ART）的病毒学和免疫反应可能与大龄儿童不同。
对肯尼亚内罗毕队列中感染HIV的婴儿和儿童的ART纵向反应进行建模和比较。参与者在HIV诊断后不久入组，开始接受ART治疗，并随访2年。使用非线性混合效应模型比较婴儿和儿童队列之间的病毒载量下降情况，使用线性混合效应模型比较CD4%的恢复情况。
在121名婴儿中，接受ART治疗时的中位年龄为3.9个月；在124名儿童中，中位年龄为4.8岁。基线时，婴儿的病毒载量高于儿童（6.47对5.91 log10拷贝/毫升，P<0.001）。接受ART治疗6个月后，婴儿将病毒载量抑制至低于250拷贝/毫升的可能性低于儿童（32%的婴儿对73%的儿童，P<0.0001）。婴儿基线时的CD4%高于儿童（19%对7.3%，P<0.001）。大龄儿童的CD4%恢复速度比婴儿快，但未能赶上婴儿的CD4%水平。
尽管开始ART治疗时婴儿的CD4%显著更高，但婴儿的病毒抑制明显比大龄儿童慢。需要新的策略来优化婴儿的ART治疗效果。
