埃塞俄比亚西北部接受抗逆转录病毒治疗前后的HIV感染儿童的血液学异常及相关因素
Hematologic abnormalities and associated factors among HIV infected children pre- and post-antiretroviral treatment, North West Ethiopia.
作者信息
Geletaw Teshome, Tadesse Meseret Zelalem, Demisse Abayneh Girma
机构信息
Department of Pediatrics and Child Health, School of Medicine, College of Medicine and Health Science, University of Gondar, Ethiopia.
出版信息
J Blood Med. 2017 Aug 4;8:99-105. doi: 10.2147/JBM.S137067. eCollection 2017.
INTRODUCTION
There are few studies on the hematologic parameters of HIV-infected individuals in Ethiopia; of these, almost all studies researched adults. Our current study is unique in that it mainly focused on the pediatric population and compared both pre- and post-antiretroviral therapy (ART) children. Inference from this study can be used for other developing countries where the burden of HIV disease is high.
OBJECTIVE
The aim of this study was to identify hematologic abnormalities in HIV-infected children before and after initiation of ART.
METHODOLOGY
A cross-sectional study was conducted on HIV-infected children from June 1 to August 30, 2015. Data were collected using a pretested and structured questionnaire. Statistical analysis was performed using SPSS 20 version.
RESULTS
The median age of study subjects was 10 years with an interquartile range (IQR) of (6, 12). Two-thirds (74.3%) of study subjects received ART for >1 year. The median of CD4 count before ART was 490 cells/mm with an IQR of (286, 765); this increased to 663 cells mm with an IQR of (499, 908) after ART. Likewise, the median of hemoglobin before ART was 11.5 mg/dL with an IQR of (9.9, 13), which increased after ART to 13 mg/dL with an IQR of (11.8, 14). The prevalence of anemia was 42.8% before and 18.9% after ART initiation. The median of absolute neutrophil count before ART was 3×10 with an IQR of (2.1, 4.6) and after ART, it became 3×10 with IQR of (1.9, 4.2). Age <5 years (adjusted odds ratio [AOR]: 2.76; 95% CI: 1.5, 5.0), an advanced stage of AIDS (AOR: 2.8; 95% CI: 1.4, 5.6) and CD4% <25% (AOR: 2.4; 95% CI: 1.2, 4.9) were significantly associated with anemia before ART initiation, while opportunistic infections were associated with anemia after initiation of ART (AOR: 2.3; 95% CI: 1.08, 4.8).
CONCLUSION
ART positively or negatively affects the hematologic profile of HIV-infected children. The current study demonstrated a significant reduction of anemia after initiation of ART.
引言
在埃塞俄比亚，针对感染艾滋病毒个体的血液学参数的研究较少；其中，几乎所有研究都针对成年人。我们当前的研究独具特色，主要聚焦于儿童群体，并对接受抗逆转录病毒疗法（ART）前后的儿童进行了比较。这项研究所得出的推论可应用于其他艾滋病毒疾病负担较重的发展中国家。
目的
本研究的目的是确定感染艾滋病毒的儿童在开始接受抗逆转录病毒治疗前后的血液学异常情况。
方法
于2015年6月1日至8月30日对感染艾滋病毒的儿童进行了一项横断面研究。通过预先测试且结构化的问卷收集数据。使用SPSS 20版本进行统计分析。
结果
研究对象的中位年龄为10岁，四分位间距（IQR）为（6，12）。三分之二（74.3%）的研究对象接受抗逆转录病毒治疗超过1年。接受抗逆转录病毒治疗前CD4细胞计数的中位数为490个细胞/mm³，四分位间距为（286，765）；接受抗逆转录病毒治疗后增至663个细胞/mm³，四分位间距为（499，908）。同样，接受抗逆转录病毒治疗前血红蛋白的中位数为11.5mg/dL，四分位间距为（9.9，13），接受抗逆转录病毒治疗后增至13mg/dL，四分位间距为（11.8，14）。贫血患病率在开始接受抗逆转录病毒治疗前为42.8%，治疗后为18.9%。接受抗逆转录病毒治疗前绝对中性粒细胞计数的中位数为3×10⁹/L，四分位间距为（2.1，4.6），治疗后变为3×10⁹/L，四分位间距为（1.9，4.2）。年龄<5岁（调整优势比[AOR]：2.76；95%置信区间[CI]：1.5，5.0）、艾滋病晚期（AOR：2.8；95%CI：1.4，5.6）以及CD4%<25%（AOR：2.4；95%CI：1.2，4.9）与开始接受抗逆转录病毒治疗前的贫血显著相关，而机会性感染与开始接受抗逆转录病毒治疗后的贫血相关（AOR：2.3；95%CI：1.08，4.8）。
结论
抗逆转录病毒疗法对感染艾滋病毒儿童的血液学特征有积极或消极影响。当前研究表明开始接受抗逆转录病毒治疗后贫血显著减少。
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