[2008年至2018年喀麦隆埃博拉瓦镇6个月至15岁接受随访的HIV感染儿童的生存决定因素]
[Determinants of survival of HIV-infected children aged 6 months to 15 years on follow-up in the town of Ebolowa, Cameroon from 2008 to 2018].
作者信息
Kalla Ginette Claude Mireille, Mve Valery-Gustave Mve, Noubi Nelly Kamgaing, Mandeng Marcelle Nina Ehouzou, Assoumou Marie Claire Okomo, Mbopi-Keou Francois Xavier, Monebenimp Francisca
机构信息
Faculté de Médecine et des Sciences Biomédicales, Université de Yaoundé I, Yaoundé, Cameroun.
Service de Pédiatrie, Centre Hospitalier et Universitaire de Yaoundé, Yaoundé, Cameroun.
出版信息
Pan Afr Med J. 2020 Dec 3;37:308. doi: 10.11604/pamj.2020.37.308.25829. eCollection 2020.
INTRODUCTION
survival of HIV-infected children is a challenge in developing countries. In Cameroon, HIV-related mortality among children under the age of 15 in 2018 was 20%. Paradoxically, the Southern Cameroon region, despite high seroprevalence among children (4.1%) and low antiretroviral therapy coverage (around 64%), is not among the regions of Cameroon most affected by HIV/AIDS-related pediatric mortality. The purpose of this study was to calculate survival rate and to identify its determinants in HIV-infected children aged 6 months-15 years.
METHODS
we conducted a retrospective, prospective cohort study data-collection in three health care facilities specialized in treating HIV-positive children in Ebolowa, South Cameroon from January 2008 to December 2018. The study was conducted in two phases, a retrospective collection phase for the selection of medical records of HIV-positive children that met inclusion criteria in consultation registries and a prospective collection phase in which we collected information from parents about the future of children. Informed parental consent was obtained during this second phase. Socio-demographic, clinical, paramedical, therapeutic data as well as data about the future of children were collected. Mean survival time and factors associated with survival were determined using the Kaplan Meier model. Cox proportional hazards regression allowed for the identification of survival determinants. Evaluation criterion was the death. Significance level was set at 5%.
RESULTS
a total of 186 patients were enrolled in the study: the average follow-up period was 18.5 months. Survival rate was 66.7%. The majority of deaths (67%) occurred before the sixth month of follow-up. After multivariate analysis, an age less than 2 years [aHR: 18.6 (6.48-53.59); p=0.001), severe anemia [aHR: 7.69 (1.02-57.9); p=0.04) and the presence of opportunistic infections [aHR: 4.52 (2.51-8.14); p=0.05] were independently and significantly associated with survival.
CONCLUSION
in addition to early antiretroviral therapy, good clinical and paraclinical monitoring is needed to improve the survival of HIV-infected children.
引言
在发展中国家，感染艾滋病毒儿童的生存是一项挑战。在喀麦隆，2018年15岁以下儿童中与艾滋病毒相关的死亡率为20%。矛盾的是，喀麦隆南部地区尽管儿童血清阳性率很高（4.1%）且抗逆转录病毒疗法覆盖率较低（约64%），但并非喀麦隆受艾滋病毒/艾滋病相关儿童死亡率影响最严重的地区。本研究的目的是计算6个月至15岁感染艾滋病毒儿童的生存率并确定其决定因素。
方法
我们于2008年1月至2018年12月在喀麦隆南部埃博洛瓦的三家专门治疗艾滋病毒阳性儿童的医疗机构进行了一项回顾性、前瞻性队列研究数据收集。该研究分两个阶段进行，一个回顾性收集阶段用于从会诊登记处选择符合纳入标准的艾滋病毒阳性儿童的病历，以及一个前瞻性收集阶段，在此阶段我们从家长那里收集有关儿童未来情况的信息。在第二阶段获得了家长的知情同意。收集了社会人口统计学、临床、辅助医疗、治疗数据以及有关儿童未来情况的数据。使用Kaplan Meier模型确定平均生存时间和与生存相关的因素。Cox比例风险回归用于确定生存决定因素。评估标准为死亡。显著性水平设定为5%。
结果
共有186名患者纳入研究：平均随访期为18.5个月。生存率为66.7%。大多数死亡（67%）发生在随访的第六个月之前。多变量分析后，年龄小于2岁[aHR：18.6（6.48 - 53.59）；p = 0.001]、重度贫血[aHR：7.69（1.02 - 57.9）；p = 0.04]和机会性感染的存在[aHR：4.52（2.51 - 8.14）；p = 0.05]与生存独立且显著相关。
结论
除了早期抗逆转录病毒疗法外，还需要良好的临床和辅助临床监测以提高感染艾滋病毒儿童的生存率。
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