Zhang Hanxi, Lao Xiaojie, Li Huiqin, Lu Hongyan, Cheng Yuewu, Song Yuxia, Zhao Qingxia, Chen Jinfeng, Ye Fuxiu, Zhao Hongxin, Zhang Fujie
WHO Collaborating Centre for Comprehensive Management of HIV Treatment and Care, Beijing Ditan Hospital, Capital Medical University, Beijing, China.
Department of HIV/AIDS, Beijing Ditan Hospital, Capital Medical University, Beijing, China.
Heliyon. 2024 Mar 26;10(7):e27961. doi: 10.1016/j.heliyon.2024.e27961. eCollection 2024 Apr 15.
Highly active antiretroviral therapy (HAART) was piloted in 2002 and was scaled up in 2003 in mainland China. The aim of this study was to evaluate the mortality and its possible predictors based on the long-term initial antiretroviral therapy (ART) cohort among HIV positive children and adolescents.
This prospective open-labeled multicenter cohort study was conducted from January 2008 to July 2021. The participants were recruited from six representative sites in mainland China. A total of 609 participants with an HIV-positive serostatus and <18 years old were recruited and each participant was informed consent at the time of enrollment. Mortality and annual hazard were calculated, and predictors for death were analyzed using Cox regression models generating hazard ratios (HR).
The results showed that the mortality was 0.721 per hundred person-years, and the annual hazard was less than 0.10 over time. Both CD4T cell count and CD4T cell percentage declined in the death group during the follow-up. The Cox regression model showed that the baseline low CD4T cell count level (Low vs. High: aHR = 8.309, 95% CI: (1.093, 63.135)) and age >5 years old at HIV diagnosis (6-12 vs. 0-5: aHR = 3.140, 95%CI: (1.331, 27.411)); 13-18 vs. 0-5: aHR = 5.451, 95%CI: (1.434, 20.724)) were possible risk factors for death.
The longitudinal cohort study demonstrated the efficacy of China's ART program among HIV-positive children and adolescents which could be beneficial to other countries with limited resources.
高效抗逆转录病毒疗法（HAART）于2002年进行试点，并于2003年在中国内地扩大应用。本研究的目的是基于HIV阳性儿童和青少年长期初始抗逆转录病毒治疗（ART）队列评估死亡率及其可能的预测因素。
本前瞻性开放标签多中心队列研究于2008年1月至2021年7月进行。参与者来自中国内地六个具有代表性的地点。共招募了609名HIV血清学阳性且年龄<18岁的参与者，每位参与者在入组时均签署了知情同意书。计算死亡率和年度风险，并使用生成风险比（HR）的Cox回归模型分析死亡的预测因素。
结果显示，死亡率为每百人年0.721，随着时间推移年度风险小于0.10。随访期间，死亡组的CD4T细胞计数和CD4T细胞百分比均下降。Cox回归模型显示，基线CD4T细胞计数水平低（低水平与高水平：校正后风险比[aHR]=8.309，95%置信区间[CI]：(1.093, 63.135)）以及HIV诊断时年龄>5岁（6 - 12岁与0 - 5岁：aHR = 3.140，95%CI：(1.331, 27.411)；13 - 18岁与0 - 5岁：aHR = 5.451，95%CI：(1.434, 20.724)）是可能的死亡风险因素。
该纵向队列研究证明了中国ART项目在HIV阳性儿童和青少年中的疗效，这可能对其他资源有限的国家有益。
