Shah Ira, Mullanfiroze Khushnuma
Pediatric HIV Clinic, Department of Pediatrics, B. J. Wadia Hospital for Children, Mumbai, Maharashtra, India.
Indian J Sex Transm Dis AIDS. 2020 Jan-Jun;41(1):17-21. doi: 10.4103/ijstd.IJSTD_108_13. Epub 2020 Jun 18.
The aim was to study the clinical profile of HIV-infected orphans living in orphanages in Mumbai, Maharashtra, India and determine the prevalence of multidrug-resistant (MDR) tuberculosis (TB) in them.
Seventy-four HIV-infected orphans from two orphanages (orphanage A taking antiretroviral therapy [ART] as per our prescription, whereas orphanage B taking ART from an ART center) were included in the study. Detailed history and examination was carried out in each patient. CDC class prior to ART, age at presentation, CD4 count/percent, opportunistic infections (OIs) prior to and after ART, co-infections with hepatitis B virus (HBV) and hepatitis C virus, growth, ART regimes, and treatment failure were noted in each patient.
Of 18 HIV-infected children in orphanage A, boys constituted 11 (61.1%) and girls were 7 (38.9%), whereas orphanage B had all girls ( = 56). TB was the most common OI in orphanage A prior to the start of ART seen in 15 (83.3%), whereas it was seen in 18 (32.1%) in orphanage B. In contrast, TB was seen in eight (14.2%) orphans in orphanage B after the start of ART, of which two (3.5%) were MDR-TB and another two (3.5%) were suspected to have MDR-TB, whereas one (5.5%) in orphanage A had MDR-TB. Age of presentation was 4.7 ± 3.2 years for orphanage A and 12.9 ± 2.5 years for orphanage B. On ART, malnutrition was seen in one child in orphanage A as compared to nine in orphanage B. ART was started at 6.1 ± 3.1 years in orphanage A and 10.1 ± 2.8 years in orphanage B. Zidovudine, lamivudine (3TC), and nevirapine (NVP)/efavirenz (EFV) constituted the baseline ART regimen in 13 (72.1%) orphans in orphanage A, whereas stavudine (d4T) + 3TC + NVP constituted the baseline ART in 17 (30.3%) orphans in orphanage B. Three (5.3%) orphans had HBV co-infection in orphanage B.
Children in orphanage A came to us at a younger age, in more advanced stage of disease, and were more malnourished. Orphanage A was started on ART earlier in life. The prevalence of TB was higher in orphanage A prior to ART. MDR-TB was seen in both orphanages, with prevalence ranging from 3.5% to 5.5%.
本研究旨在调查印度马哈拉施特拉邦孟买孤儿院中感染艾滋病毒孤儿的临床特征,并确定他们中耐多药结核病(MDR-TB)的患病率。
本研究纳入了来自两家孤儿院的74名感染艾滋病毒的孤儿(孤儿院A按照我们的处方接受抗逆转录病毒治疗[ART],而孤儿院B从一个抗逆转录病毒治疗中心接受ART)。对每位患者进行了详细的病史询问和检查。记录了每位患者ART治疗前的疾病控制与预防中心(CDC)分级、就诊年龄、CD4细胞计数/百分比、ART治疗前后的机会性感染(OIs)、乙型肝炎病毒(HBV)和丙型肝炎病毒的合并感染情况、生长发育情况、ART治疗方案以及治疗失败情况。
在孤儿院A的18名感染艾滋病毒的儿童中,男孩有11名(61.1%),女孩有7名(38.9%),而孤儿院B的全部是女孩(n = 56)。在孤儿院A,ART治疗开始前,结核病是最常见的机会性感染,15名(83.3%)儿童出现该感染,而在孤儿院B,这一比例为18名(32.1%)。相比之下,在孤儿院B,ART治疗开始后,8名(14.2%)孤儿出现结核病,其中2名(3.5%)为耐多药结核病,另外2名(3.5%)疑似耐多药结核病,而在孤儿院A,1名(5.5%)儿童为耐多药结核病。孤儿院A的就诊年龄为4.7±3.2岁,孤儿院B为12.9±2.5岁。接受ART治疗后,孤儿院A有1名儿童出现营养不良,而孤儿院B有9名。孤儿院A在6.1±3.1岁开始ART治疗,孤儿院B在10.1±2.8岁开始。齐多夫定、拉米夫定(3TC)和奈韦拉平(NVP)/依非韦伦(EFV)构成了孤儿院A中13名(72.1%)孤儿的基线ART治疗方案,而司他夫定(d4T)+3TC+NVP构成了孤儿院B中17名(30.3%)孤儿的基线ART治疗方案。孤儿院B有3名(5.3%)孤儿合并感染HBV。
孤儿院A的儿童就诊年龄更小,疾病处于更晚期,且营养不良情况更严重。孤儿院A的儿童更早开始接受ART治疗。在ART治疗前,孤儿院A的结核病患病率更高。两家孤儿院均发现了耐多药结核病,患病率在3.5%至5.5%之间。