2019 年巴基斯坦信德省主要影响儿童的 HIV 感染：疫情的横断面研究。

HIV infection predominantly affecting children in Sindh, Pakistan, 2019: a cross-sectional study of an outbreak.

机构信息

Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan.

Department of Medicine, Aga Khan University, Karachi, Pakistan.

出版信息

Lancet Infect Dis. 2020 Mar;20(3):362-370. doi: 10.1016/S1473-3099(19)30743-1. Epub 2019 Dec 19.

DOI:10.1016/S1473-3099(19)30743-1

PMID:31866326

Abstract

BACKGROUND

In April 2019, an HIV screening camp for all ages was established in response to a report of an unusually large number of paediatric HIV diagnoses in Larkana, Pakistan. We aimed to understand the clinical profile of the children who registered for HIV care.

METHODS

In this cross-sectional study, we review the outbreak response from the government, academia, and UN agencies in Larkana, Sindh, Pakistan. We report age-stratified and sex-stratified HIV prevalence estimated among individuals screened. For children who registered for HIV care, clinical history of previous injections and blood transfusions, HIV disease stage, hepatitis B and hepatitis C status, and CD4 count was abstracted from clinical records from Sindh AIDS Control Program HIV Clinic (Shaikh Zayed Childrens Hospital, Larkana, Pakistan) and analysed using percentages, χ tests, and weight-for-age Z scores. We also analysed data for parents who were tested for HIV.

FINDINGS

Between April 24, and July 15, 2019, 31 239 individuals underwent HIV testing, of whom 930 (3%) tested positive for HIV. Of these, 763 (82%) were younger than 16 years and 604 (79%) of these were aged 5 years and below. Estimated HIV prevalence was 3% overall; 7% (283 of 3803) in children aged 0-2 years, 6% (321 of 5412) in children aged 3-5 years, and 1% (148 of 11 251) in adults aged 16-49 years. Of the 591 children who registered for HIV care, 478 (81%) were 5 years or younger, 379 (64%) were boys, and 315 (53%) of 590 had a weight-for-age Z score of -3·2. Prevalence of hepatitis B surface antigen was 8% (48 of 574) and hepatitis C antibody positivity was 3% (15 of 574). Of children whose mothers tested for HIV, only 39 (11%) of 371 had HIV-positive mothers. Most children (404 [89%] of 453) reported multiple previous injections and 40 (9%) of 453 reported blood transfusions.

INTERPRETATION

This HIV outbreak is unprecedented among children in Pakistan: a 54% increase in paediatric HIV diagnoses over the past 13 years. The outbreak was heavily skewed towards young children younger than 5 years, with a predominance of boys. Epidemiological and molecular studies are needed to understand the full extent of the outbreak and its drivers to guide HIV control strategies.

FUNDING

None.

摘要

背景

2019 年 4 月，为应对巴基斯坦拉尔卡纳报告的儿童 HIV 诊断数量异常增多的情况，开展了一次面向各年龄段的 HIV 筛查活动。本研究旨在了解登记接受 HIV 护理的儿童的临床特征。

方法

在这项横断面研究中，我们回顾了巴基斯坦信德省拉尔卡纳地区政府、学术界和联合国机构的疫情应对情况。我们报告了在接受筛查的人群中按年龄和性别分层的 HIV 感染率。对于登记接受 HIV 护理的儿童，我们从信德省艾滋病控制项目 HIV 诊所（巴基斯坦拉尔卡纳谢赫·扎耶德儿童医院）的临床记录中提取了既往注射和输血史、HIV 疾病分期、乙型肝炎和丙型肝炎状态以及 CD4 计数等临床病史，并使用百分比、卡方检验和体重年龄 Z 评分进行分析。我们还分析了接受 HIV 检测的父母的数据。

结果

2019 年 4 月 24 日至 7 月 15 日期间，共有 31239 人接受了 HIV 检测，其中 930 人（3%）HIV 检测呈阳性。其中，763 人（82%）年龄小于 16 岁，其中 604 人（79%）年龄在 5 岁及以下。总体 HIV 感染率为 3%；0-2 岁儿童中为 7%（283/3803），3-5 岁儿童中为 6%（321/5412），16-49 岁成年人中为 1%（148/11251）。在登记接受 HIV 护理的 591 名儿童中，478 人（81%）年龄在 5 岁及以下，379 人（64%）为男孩，315 人（53%）体重年龄 Z 评分低于-3.2。乙型肝炎表面抗原阳性率为 8%（48/574），丙型肝炎抗体阳性率为 3%（15/574）。在接受 HIV 检测的母亲中，只有 39 名（371 名中的 11%）母亲 HIV 检测呈阳性。大多数儿童（404 名[89%]，453 名）报告多次既往注射，40 名（9%），453 名）报告曾输血。