出生后第一个月开始抗逆转录病毒治疗。

Antiretroviral Treatment Initiated in the First Month of Life.

作者信息

Frigati Lisa, Wynberg Elke, Maritz Jean, Holgate Sandi, Cotton Mark F, Rabie Helena

机构信息

From the *Division of Paediatric Infectious Diseases and Department of Paediatrics and Child Health, Tygerberg Children's Hospital, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa; †School of Medicine, Imperial College London, London, United Kingdom; ‡Division of Medical Virology, Department of Pathology, Stellenbosch University and the National Health Laboratory Service, Tygerberg Hospital, Cape Town, South Africa; and §Division of Neonatology and Department of Paediatrics and Child Health, Tygerberg Children's Hospital, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa.

出版信息

Pediatr Infect Dis J. 2017 Jun;36(6):584-587. doi: 10.1097/INF.0000000000001504.

DOI:10.1097/INF.0000000000001504

PMID:28027284

Abstract

BACKGROUND

Earlier diagnosis of HIV-infected infants facilitates earlier access to therapy and improved clinical outcomes. The aim of this study was to describe the management of infants who started antiretroviral therapy (ART) in the first month of life.

METHODS

A retrospective review was performed on HIV-infected neonates who started ART within the first month of life between January 2013 and March 2015.

RESULTS

A total of 997 neonates had 1 HIV polymerase chain reaction test. Of the 997 neonates, 26 (2.6%) tested positive for HIV and 22 initiated therapy in the first month of life. The median age of first HIV polymerase chain reaction test was 7 days. Neonates were started on ART within a median of 7 days of their first HIV test, which equated to a median age of 13.5 [interquartile range (IQR) 7-20] days of life. Median gestational age was 35 weeks (IQR 33-38 weeks), and birth weight was 2170 g (IQR 1773-2480). Nineteen (86.4%) had low birth weight (<2.5 kg) and 16 (72.7%) were premature. Median baseline HIV viral loads were log 4.444 copies/mL (IQR 3.457-5.125), median CD4 counts were 1338 (IQR 803-1928) and CD4% percentages were 36.1% (22.2-45.4). All children initiated zidovudine and lamivudine, 10 with lopinavir/ritonavir and 12 with nevirapine. All children in care are now receiving lopinavir/ritonavir. Of the 22 neonates initiated on treatment, 11 are in care (mean age, 2.1 years), and 2 of these infants had a viral load of <50 copies/ mL when last measured.

CONCLUSIONS

Early ART initiation in neonates is feasible. Challenges include safe, palatable regimens and continued close follow-up of mothers and infants.

摘要

背景

对感染艾滋病毒的婴儿进行早期诊断有助于更早获得治疗并改善临床结局。本研究的目的是描述在出生后第一个月开始抗逆转录病毒治疗（ART）的婴儿的管理情况。

方法

对2013年1月至2015年3月期间在出生后第一个月内开始接受ART治疗的感染艾滋病毒的新生儿进行回顾性研究。

结果

共有997名新生儿进行了1次艾滋病毒聚合酶链反应检测。在这997名新生儿中，26名（2.6%）艾滋病毒检测呈阳性，22名在出生后第一个月开始接受治疗。首次艾滋病毒聚合酶链反应检测的中位年龄为7天。新生儿在首次艾滋病毒检测后的中位7天内开始接受ART治疗，这相当于出生后的中位年龄为13.5[四分位间距（IQR）7 - 20]天。中位胎龄为35周（IQR 33 - 38周），出生体重为2170克（IQR 1773 - 2480）。19名（86.4%）出生体重低（<2.5千克），16名（72.7%）为早产儿。基线艾滋病毒病毒载量中位数为log 4.444拷贝/毫升（IQR 3.457 - 5.125），CD4细胞计数中位数为1338（IQR 803 - 1928），CD4%百分比为36.1%（22.2 - 45.4）。所有儿童均开始服用齐多夫定和拉米夫定，10名服用洛匹那韦/利托那韦，12名服用奈韦拉平。目前所有接受治疗的儿童都在服用洛匹那韦/利托那韦。在开始治疗的22名新生儿中，11名仍在接受治疗（平均年龄2.1岁），其中2名婴儿上次检测时病毒载量<50拷贝/毫升。