围生期感染 HIV 的青少年过渡到成人护理后的死亡率：西班牙的研究。

Mortality in Perinatally HIV-infected Adolescents After Transition to Adult Care in Spain.

机构信息

From the Department of Paediatrics, Clínico San Carlos Hospital.

Instituto de Investigación Sanitaria Gregorio Marañón (IisGM), Gregorio Marañón Hospital, CoRISpe, Madrid.

出版信息

Pediatr Infect Dis J. 2021 Apr 1;40(4):347-350. doi: 10.1097/INF.0000000000003009.

DOI:10.1097/INF.0000000000003009

PMID:33264211

Abstract

INTRODUCTION

After the introduction of combination antiretroviral treatment, (ART) mortality in HIV-infected patients has dramatically decreased. However, it is still high in patients at risk, as adolescents transitioning to adult care (AC) without virologic control. The aim of this study was to characterize mortality and comorbidities of perinatally infected HIV (PHIV) patients after transition to AC.

METHODS

A multicenter retrospective study from patients included in the CoRISpe-FARO Spanish cohort was conducted. PHIV patients who died after transition to AC between 2009 and 2019 were included. Clinical, immunovirologic characteristics, treatments received, comorbidities and causes of death were described.

RESULTS

Among 401 PHIV patients, 14 died (3.5%). All were Spanish, 11/14 (78.6%) women. The median age at diagnosis was 1.5 years (interquartile range [IQR] 0.5-3.9), at transfer to AC was 18 years [16.1-19.9] and at death was 25.8 years [23.6-27.1]. In pediatric units [pediatric care (PC)], CD4+ nadir was 85 cells/μL [IQR 9.7-248.5] and 6/14 patients were classified as C-clinical stage. During AC, all patients were on C-clinical stage and CD4+ nadir dropped to 11.5 cells/μL [4.5-43.3]. cART adherence was extremely poor: in PC, 8/14 patients registered voluntary treatment interruptions; only one had undetectable VL at transition. In AC, 12/14 patients stopped treatment 2 or more periods of time. All deaths were related to advanced HIV disease. Mental health disorders were observed in 7/14 (50%). Main complications described: recurrent bacterial infections (57.1%), wasting syndrome (42.9%), esophageal candidiasis (28.6%) and Pneumocystis jirovecii pneumonia (28.6%). Four women had 11 pregnancies; 5 children were born (none infected).

CONCLUSIONS

Young adults PHIV infected who transition to AC without virologic suppression or proven ability to adhere to ART are at high risk of mortality. Mortality was noted as a consequence of advanced HIV disease, frequent mental health problems and poor adherence to ART.

摘要

简介

自联合抗逆转录病毒治疗（ART）问世以来，HIV 感染者的死亡率已大幅下降。然而，对于那些在青少年时期未得到病毒学控制就过渡到成人护理（AC）的患者，死亡率仍然很高。本研究的目的是描述接受 AC 后，经母婴传播感染 HIV（PHIV）患者的死亡率和合并症。

方法

该研究是一项多中心回顾性研究，对象为参加 CoRISpe-FARO 西班牙队列的患者。研究纳入了 2009 年至 2019 年间过渡到 AC 后死亡的 PHIV 患者。描述了患者的临床、免疫病毒学特征、接受的治疗、合并症和死亡原因。

结果

在 401 名 PHIV 患者中，有 14 人死亡（3.5%）。所有患者均为西班牙人，其中 11 名（78.6%）为女性。诊断时的中位年龄为 1.5 岁（四分位间距 [IQR] 0.5-3.9），转至 AC 时的年龄为 18 岁[16.1-19.9]，死亡时的年龄为 25.8 岁[23.6-27.1]。在儿科单位[儿科护理（PC）]，CD4+ 细胞计数的最低值为 85 个/μL [IQR 9.7-248.5]，6/14 名患者被归类为 C 期临床。在 AC 期间，所有患者均处于 C 期临床，CD4+ 细胞计数最低值下降至 11.5 个/μL [4.5-43.3]。cART 依从性极差：在 PC 期间，14 名患者中有 8 人自愿中断治疗；仅有 1 人在过渡时 VL 不可检测。在 AC 期间，14 名患者中有 12 人停止治疗 2 个或更多周期。所有死亡均与 HIV 疾病晚期有关。14 名患者中有 7 名（50%）出现精神健康障碍。描述的主要并发症：反复细菌感染（57.1%）、消耗综合征（42.9%）、食管念珠菌病（28.6%）和肺孢子菌肺炎（28.6%）。4 名女性有 11 次妊娠；5 名儿童出生（均未感染）。