南部非洲围生期感染 HIV 的青少年的特征和结局。

Characteristics and outcomes of adolescents living with perinatally acquired HIV within Southern Africa.

机构信息

Centre for Infectious Disease Epidemiology & Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town.

Empilweni Services and Research Unit, Department of Paediatrics & Child Health, Faculty of Health Sciences, Rahima Moosa Mother and Child Hospital, University of the Witwatersrand, Johannesburg.

出版信息

AIDS. 2020 Dec 1;34(15):2275-2284. doi: 10.1097/QAD.0000000000002683.

DOI:10.1097/QAD.0000000000002683

PMID:32910063

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7674245/

Abstract

BACKGROUND

Using data from 15 International epidemiology Databases to Evaluate AIDS in Southern Africa sites, we compared the characteristics and outcomes of adolescents living with perinatally acquired HIV (ALPH).

METHODS

We included ALPH entering care aged less than 13 years with at least one HIV care visit during adolescence (10-19 years). We compared the characteristics and cross-sectional outcomes: transfer out, loss to follow-up (no visit in the 12 months prior to database closure), mortality, and retention between those who entered care aged less than 10 vs. aged 10-13 years; and explored predictors of mortality after age 13 years using Cox Proportional Hazards models.

RESULTS

Overall, 16 229 (50% female) ALPH who entered HIV care aged less than 10 years and 8897 (54% female) aged 10-13 years were included and followed for 152 574 person-years. During follow-up, 94.1% initiated antiretroviral therapy, with those who entered care aged less than 10 more likely to have initiated antiretroviral therapy [97.9%, 95% confidence interval (CI) 97.6; 98.1%] than those who presented aged 10-13 years (87.3%, 95% CI 86.6; 88.0%). At the end of follow-up, 3% had died (entered care aged <10 vs. 10-13 years; 1.4 vs. 5.1%), 22% were loss to follow-up (16.2 vs. 33.4%), and 59% (66.4 vs. 45.4%) were retained. There was no difference in the risk of dying after the age of 13 years between adolescents entering care aged less than 10 vs. 10-13 years (adjusted hazard ratio 0.72; 95% CI 0.36; 1.42).

CONCLUSION

Retention outcomes for ALPH progressively worsened with increasing age, with these outcomes substantially worse among adolescents entering HIV care aged 10-13 vs. less than 10 years.

摘要

背景

我们利用来自 15 个国际流行病学数据库评估南部非洲艾滋病项目中获得性母婴传播 HIV（ALPH）患者的特征和结局，比较了小于 13 岁进入艾滋病护理且在青少年时期（10-19 岁）至少有一次 HIV 护理就诊的 ALPH 的特征和横断面结局：转出、失访（数据库关闭前 12 个月内无就诊）、死亡和保留率；并使用 Cox 比例风险模型探索了 13 岁以后死亡的预测因素。

方法

我们纳入了小于 10 岁和 10-13 岁进入艾滋病护理的 ALPH 患者，前者进入护理时年龄小于 10 岁，且至少有一次 HIV 护理就诊，随访时间至少 152574 人年。在随访期间，94.1%的患者开始接受抗逆转录病毒治疗，其中小于 10 岁进入护理的患者开始抗逆转录病毒治疗的比例更高[97.9%，95%置信区间（CI）97.6%；98.1%]，而 10-13 岁进入护理的患者开始抗逆转录病毒治疗的比例较低[87.3%，95% CI 86.6%；88.0%]。随访结束时，3%的患者死亡（进入护理时年龄小于 10 岁与 10-13 岁相比；1.4%比 5.1%），22%的患者失访（16.2%比 33.4%），59%的患者保留（66.4%比 45.4%）。13 岁以后，进入护理时年龄小于 10 岁与 10-13 岁的青少年死亡风险无差异（调整后的危险比 0.72；95% CI 0.36；1.42）。