The Kirby Institute, UNSW Australia, Sydney, New South Wales, Australia.
Children's Hospital 1, Ho Chi Minh City, Vietnam.
AIDS. 2018 Jul 31;32(12):1689-1697. doi: 10.1097/QAD.0000000000001883.
The aim of this study was to describe characteristics of perinatally HIV-infected adolescents (PHIVAs), factors associated with mortality, and outcomes at transition.
Ongoing observational database collating clinical data on HIV-infected children and adolescents in Asia.
Data from 2001 to 2016 relating to adolescents (10-19 years) with perinatal HIV infection were analysed to describe characteristics at adolescent entry and transition and combination antiretroviral therapy (cART) regimens across adolescence. A competing risk regression analysis was used to determine characteristics at adolescent entry associated with mortality. Outcomes at transition were compared on the basis of age at cART initiation.
Of 3448 PHIVA, 644 had reached transition. Median age at HIV diagnosis was 5.5 years, cART initiation 7.2 years and transition 17.9 years. At adolescent entry, 35.0% had CD4+ cell count less than 500 cells/μl and 51.1% had experienced a WHO stage III/IV clinical event. At transition, 38.9% had CD4+ cell count less than 500 copies/ml, and 53.4% had experienced a WHO stage III/IV clinical event. Mortality rate was 0.71 per 100 person-years, with HIV RNA ≥1000 copies/ml, CD4+ cell count less than 500 cells/μl, height-for-age or weight-for-age z-score less than -2, history of a WHO stage III/IV clinical event or hospitalization and at least second cART associated with mortality. For transitioning PHIVA, those who commenced cART age less than 5 years had better virologic and immunologic outcomes, though were more likely to be on at least second cART.
Delayed HIV diagnosis and cART initiation resulted in considerable morbidity and poor immune status by adolescent entry. Durable first-line cART regimens to optimize disease control are key to minimizing mortality. Early cART initiation provides the best virologic and immunologic outcomes at transition.
本研究旨在描述围生期感染 HIV 的青少年（PHIVA）的特征、与死亡率相关的因素以及过渡时期的结局。
对亚洲感染 HIV 的儿童和青少年进行连续观察的数据库，收集临床数据。
对 2001 年至 2016 年期间患有围生期 HIV 感染的青少年（10-19 岁）的数据进行分析，以描述青少年进入期和过渡期的特征以及整个青春期的联合抗逆转录病毒治疗（cART）方案。采用竞争风险回归分析确定与死亡率相关的青少年进入期特征。根据 cART 起始年龄比较过渡时期的结局。
在 3448 名 PHIVA 中，有 644 名进入了过渡期。HIV 诊断时的中位年龄为 5.5 岁，开始 cART 的中位年龄为 7.2 岁，过渡的中位年龄为 17.9 岁。在青少年进入期，35.0%的患者 CD4+细胞计数<500 个/μl，51.1%的患者经历过世界卫生组织（WHO）III/IV 期临床事件。在过渡时期，38.9%的患者 CD4+细胞计数<500 个/ml，53.4%的患者经历过 WHO III/IV 期临床事件。死亡率为 0.71/100 人年，与 HIV RNA≥1000 拷贝/ml、CD4+细胞计数<500 个/μl、身高或体重 z 评分<-2、有 WHO III/IV 期临床事件或住院史以及至少第二种 cART 相关。对于即将进入过渡期的 PHIVA，那些在 5 岁以下开始接受 cART 的患者具有更好的病毒学和免疫学结局，但更有可能使用至少第二种 cART。
HIV 诊断和 cART 起始延迟导致青少年进入期出现大量并发症和较差的免疫状态。使用持久的一线 cART 方案来优化疾病控制是降低死亡率的关键。早期开始 cART 可在过渡时期获得最佳的病毒学和免疫学结局。
