Shabangu Patrick, Beke Andy, Manda Samuel, Mthethwa Nobuhle
a Institute for Health Measurement , Mbabane Swaziland.
b School of Health Systems and Public Health, Faculty of Health Sciences , University of Pretoria , South Africa.
Afr J AIDS Res. 2017 Dec;16(4):335-343. doi: 10.2989/16085906.2017.1386219.
The objective of the study was to determine predictors of survival among HIV-positive children (<15 years) in Swaziland. A retrospective cohort analysis of medical records for 4 167 children living with HIV who were initiated on antiretroviral therapy (ART) between 2004 and 2008, and followed up until 2014 was conducted in clinical settings at 36 health facilities. The Kaplan Meier Estimator, signed-ranks test, and the Cox proportional hazards regression model were applied to determine survival probabilities, significant difference among stratified survival functions and adjusted hazard ratios respectively. The results reveal that the median survival time for children was 78 months (95% CI: 77-79). Children who were initiated early on ART had higher survival probability over time (HR: 0.35 [95% CI: 0.21-0.57], p < 0.001) compared to those whose ART initiation was delayed. Children within the age group of <1 years had higher hazard (HR = 1.55 [95% CI: 1.16-2.08], p < 0.001) of death than children within the age group of 1-14 years. Children who were nourished had 88% lower hazard of death (HR: 0.12 [95% CI: 0.07-0.19], p < 0.001) than severely malnourished children. The study demonstrates that ART paediatric services are effective in increasing survival among HIV infected children and early initiated children have high survival probability. Active tuberculosis (TB), malnutrition, and delayed ART initiation remain predictors of poor survival among children living with HIV.
该研究的目的是确定斯威士兰15岁以下HIV阳性儿童的生存预测因素。对2004年至2008年间开始接受抗逆转录病毒治疗（ART）并随访至2014年的4167名HIV感染儿童的病历进行了回顾性队列分析，研究在36个医疗机构的临床环境中开展。应用Kaplan Meier估计器、符号秩检验和Cox比例风险回归模型分别确定生存概率、分层生存函数之间的显著差异和调整后的风险比。结果显示，儿童的中位生存时间为78个月（95%CI：77-79）。与ART起始延迟的儿童相比，早期开始接受ART治疗的儿童随着时间推移有更高的生存概率（HR：0.35[95%CI：0.21-0.57]，p<0.001）。1岁以下年龄组的儿童比1-14岁年龄组的儿童有更高的死亡风险（HR=1.55[95%CI：1.16-2.08]，p<0.001）。营养良好的儿童比严重营养不良的儿童死亡风险低88%（HR：0.12[95%CI：0.07-0.19]，p<0.001）。该研究表明，ART儿科服务在提高HIV感染儿童的生存率方面是有效的，早期开始治疗的儿童有较高的生存概率。活动性结核病（TB）、营养不良和ART起始延迟仍然是HIV感染儿童生存不良的预测因素。
