亚太地区基线患有严重贫血的艾滋病毒感染儿童：抗逆转录病毒疗法及治疗结果

HIV-infected children in the Asia-Pacific region with baseline severe anemia: antiretroviral therapy and outcomes.

作者信息

Lumbiganon Pagakrong, Kosalaraksa Pope, Bunupuradah Torsak, Boettiger David, Saphonn Vonthanak, Truong Khanh H, Kurniati Nia, Hansudewechakul Rawiwan, Do Viet C, Sudjaritruk Tavitiya, Kumarasamy Nagalingeswaran, Kongstan Nantakar, Yusoff Nik K N, Nguyen Lam V, Wati Dewi K, Razali Kamarul, Sohn Annette H, Kariminia Azar

机构信息

Division of Infectious Diseases, Department of Pediatrics, Khon Kaen University, Khon Kaen 40002, Thailand.

HIV-NAT, the Thai Red Cross AIDS Research Centre, Bangkok 10330, Thailand.

出版信息

Asian Biomed (Res Rev News). 2016 Jun;10(3):229-234.

PMID:28239430

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5321077/

Abstract

BACKGROUND

Severe anemia is common among children infected with human immunodeficiency virus (HIV). The choice of antiretroviral (ART) regimen needs careful consideration. No information is available regarding the initial ART regimens used in the Asia-Pacific region and the rate of switch of ART regimens in HIV-infected children with severe anemia.

OBJECTIVES

To study the initial ART regimens and the rate of switch of ART regimens used during the first 36 months in HIV-infected children with severe anemia and to evaluate their clinical and laboratory outcomes.

METHODS

We analyzed regional cohort data of 130 Asian children aged <18 years with baseline severe anemia (hemoglobin <7.5 g/dl) who started antiretroviral therapy (ART) between January 2003 and September 2013.

RESULTS

At ART initiation, median age was 3.5 years old (interquartile range (IQR) 1.7 to 6.3) and median hemoglobin was 6.7 g/dL (IQR 5.9-7.1, range 3.0-7.4). Initial ART regimens included stavudine (85.4%), zidovudine (13.8%), and abacavir (0.8%). In 81 children with available hemoglobin data after 6 months of ART, 90% recovered from severe anemia with a median hemoglobin of 10.7 g/dL (IQR 9.6-11.7, range 4.4-13.5). Those starting AZT-based ART had a mortality rate of 10.8 (95% confidence interval (CI) 4.8-23.9) per 100 patient-years compared to 2.7 (95% CI 1.6-4.6) per 100 patient-years among those who started d4T-based ART.

CONCLUSIONS

With the phase-out of stavudine, age-appropriate non-zidovudine options are needed for younger Asian children with severe anemia.

摘要

背景

严重贫血在感染人类免疫缺陷病毒（HIV）的儿童中很常见。抗逆转录病毒（ART）治疗方案的选择需要仔细考虑。关于亚太地区用于HIV感染严重贫血儿童的初始ART治疗方案以及ART治疗方案的更换率，目前尚无相关信息。

目的

研究HIV感染严重贫血儿童在最初36个月内使用的初始ART治疗方案及其更换率，并评估其临床和实验室结果。

方法

我们分析了2003年1月至2013年9月期间开始抗逆转录病毒治疗（ART）的130名年龄小于18岁、基线时患有严重贫血（血红蛋白<7.5 g/dl）的亚洲儿童的区域队列数据。

结果

开始ART治疗时，中位年龄为3.5岁（四分位间距（IQR）1.7至6.3），中位血红蛋白为6.7 g/dL（IQR 5.9 - 7.1，范围3.0 - 7.4）。初始ART治疗方案包括司他夫定（85.4%）、齐多夫定（13.8%）和阿巴卡韦（0.8%）。在81名ART治疗6个月后有血红蛋白数据的儿童中，90%从严重贫血中恢复，中位血红蛋白为10.7 g/dL（IQR 9.6 - 11.7，范围4.4 - 13.5）。与开始基于司他夫定的ART治疗的患者相比，开始基于齐多夫定的ART治疗的患者每100患者年的死亡率为10.8（95%置信区间（CI）4.8 - 23.9），而开始基于司他夫定的ART治疗的患者每100患者年的死亡率为2.7（95% CI 1.6 - 4.6）。