秘鲁感染 HIV 的儿童队列 2003-2012 年的发病率和死亡率。

Morbidity and Mortality of a Cohort of Peruvian HIV-infected Children 2003-2012.

机构信息

From the University of California, Los Angeles, Los Angeles, California.

Universidad Peruana Cayetano Heredia, Lima, Peru.

出版信息

Pediatr Infect Dis J. 2018 Jun;37(6):564-569. doi: 10.1097/INF.0000000000001865.

DOI:10.1097/INF.0000000000001865

PMID:29227466

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5953766/

Abstract

BACKGROUND

Data on pediatric HIV in Peru are limited. The National Institute of Child Health (Instituto Nacional de Salud del Niño: INSN) cares for the most HIV-infected children under the age of 18 years in the country. We describe the outcomes of children seen at INSN's HIV clinic over the 10 years when antiretroviral therapy and prevention of mother-to-child transmission (PMTCT) interventions became available in 2004.

METHODS

We conducted a retrospective review of INSN HIV clinic patients between 2003 and 2012. Deidentified data were collected and analyzed.

RESULTS

A total of 280 children were included: 50.0% (140/280) were male; 80.0% (224/280) lived in metropolitan Lima. Perinatal transmission was the mode of HIV infection in 91.4% (256/280) of children. Only 17% (32/191) of mothers were known to be HIV-infected at delivery; of these mothers, 41% (13/32) were receiving antiretroviral therapy at delivery, 72% (23/32) delivered by Cesarean section and 47% (15/32) of their infants received antiretroviral prophylaxis. Median age at HIV diagnosis for all children was 35.7 months (interquartile range 14.5-76.8 months), and 67% (143/213) had advanced disease (clinical stage C). After HIV diagnosis, the most frequent hospitalization discharge diagnoses were bacterial pneumonia, chronic malnutrition, diarrhea, anemia and tuberculosis. Twenty-four patients (8.6%) died at a median age of 77.4 months.

CONCLUSIONS

Most cases of pediatric HIV were acquired via perinatal transmission; few mothers were diagnosed before delivery; and among mothers with known HIV status, PMTCT was suboptimal even after national PMTCT policy was implemented. Most children were diagnosed with advanced disease. These findings underscore the need for improving early pediatric HIV diagnosis and treatment, as well as PMTCT strategies.

摘要

背景

秘鲁的儿科 HIV 数据有限。国家儿童健康研究所（Instituto Nacional de Salud del Niño: INSN）负责治疗该国年龄在 18 岁以下的大多数 HIV 感染儿童。我们描述了 2004 年开始提供抗逆转录病毒治疗和母婴传播预防（PMTCT）干预措施的 10 年间 INSN HIV 诊所就诊儿童的结局。

方法

我们对 2003 年至 2012 年期间 INSN HIV 诊所的患者进行了回顾性研究。收集并分析了匿名数据。

结果

共纳入 280 名儿童：50.0%（140/280）为男性；80.0%（224/280）居住在利马大都市区。91.4%（256/280）的儿童为围产期传播感染 HIV。仅 17%（32/191）的母亲在分娩时已知 HIV 感染；其中 41%（13/32）在分娩时接受抗逆转录病毒治疗，72%（23/32）行剖宫产，47%（15/32）的婴儿接受抗逆转录病毒预防。所有儿童的 HIV 诊断中位年龄为 35.7 个月（四分位距 14.5-76.8 个月），67%（143/213）患有晚期疾病（临床分期 C）。HIV 诊断后，最常见的出院诊断为细菌性肺炎、慢性营养不良、腹泻、贫血和结核病。24 名患者（8.6%）在中位年龄 77.4 个月时死亡。