Jackson Charlotte, Crichton Siobhan, Judd Ali, Bamford Alasdair, Goulder Philip, Klein Nigel, Marques Laura, Paioni Paolo, Riordan Andrew, Spoulou Vana, Vieira Vinicius Adriano, Ansone Santa, Chiappini Elena, Le Coeur Sophie, Ene Luminita, Galli Luisa, Giaquinto Carlo, Goetghebuer Tessa, Fortuny Claudia, Kanjanavanit Suparat, Marczynska Magda, Navarro Marisa, Naver Lars, Ngo-Giang-Huong Nicole, Plotnikova Yulia K, Plynskey Aleksey A, Ramos Jose Tomas, Raus Irina, Rozenberg Vladimir Y, Samarina Anna V, Schölvinck Elisabeth H, Vasylenko Natalia, Volokha Alla, Collins Intira Jeannie, Goodall Ruth
MRC Clinical Trials Unit at UCL, University College London, UK.
Fondazione Penta ETS, Padua, Italy.
AIDS. 2025 May 1;39(6):746-759. doi: 10.1097/QAD.0000000000004136. Epub 2025 Feb 4.
To estimate the probability of long-term nonprogression (LTNP) in the absence of antiretroviral treatment (ART) in children with perinatally acquired HIV, and the impact of LTNP definitions on these estimates.
Analysis of longitudinal routine care data (follow-up to 2016) collected through a collaboration of cohorts of children in routine HIV care across Europe and Thailand.
LTNP was defined as reaching age 8 years without disease progression (defined as an AIDS diagnosis or immunosuppression based on WHO immunosuppression-for-age thresholds, age-adjusted CD4 +z -scores or CD4 + counts). ART initiation was treated as a competing risk (children initiating ART before age 8 were not considered to have LTNP). We included children born domestically in six national HIV cohorts ( n = 2481). Additional analyses included domestic-born children enrolled in national cohorts in infancy (aged <12 months, n = 1144, six cohorts), or all domestic-born children in national and nonnational cohorts ( n = 4542, 18 cohorts). Results were stratified by birth year.
Among children born domestically in national cohorts in 2004-2007, the probability [95% confidence interval (CI)] of LTNP at age 8 years was 10% (6-15%) based on WHO immunosuppression-for-age criteria. This was lower for children born earlier when ART use was less frequent. Results were similar using other immunosuppression thresholds. Estimates were lower when restricted to domestic-born children in national cohorts enrolled in infancy, and higher when including all domestic-born children.
Up to 10% of children born during 2004-2007 had LTNP at age 8. Our findings may help identify participants with LTNP for research into posttreatment control and HIV cure.
评估围产期感染艾滋病毒的儿童在未接受抗逆转录病毒治疗（ART）情况下长期病情无进展（LTNP）的概率，以及LTNP定义对这些评估的影响。
对通过欧洲和泰国常规艾滋病毒护理儿童队列合作收集的纵向常规护理数据（随访至2016年）进行分析。
LTNP定义为达到8岁且无疾病进展（根据世界卫生组织年龄相关免疫抑制阈值、年龄校正CD4 + z分数或CD4 +细胞计数定义为艾滋病诊断或免疫抑制）。ART启动被视为竞争风险（8岁前开始接受ART的儿童不被视为LTNP）。我们纳入了六个国家艾滋病毒队列中在国内出生的儿童（n = 2481）。额外分析包括婴儿期（年龄<12个月，n = 1144，六个队列）参加国家队列的国内出生儿童，或国家和非国家队列中的所有国内出生儿童（n = 4542，18个队列）。结果按出生年份分层。
在2004 - 2007年国家队列中在国内出生的儿童中，根据世界卫生组织年龄相关免疫抑制标准，8岁时LTNP的概率[95%置信区间（CI）]为10%（6 - 15%）。对于更早出生且ART使用频率较低的儿童，该概率更低。使用其他免疫抑制阈值时结果相似。当仅限于婴儿期参加国家队列的国内出生儿童时估计值较低，而纳入所有国内出生儿童时估计值较高。
2004 - 2007年期间出生的儿童中，高达10%在8岁时LTNP。我们的研究结果可能有助于识别LTNP参与者，以进行治疗后控制和艾滋病毒治愈研究。
