坦桑尼亚农村地区儿童的重度艾滋病病情及死亡率趋势

Trends of severe HIV disease and mortality among children in rural Tanzania.

作者信息

Moshi L S, Okuma J, Luoga E, Kalinjuma A V, Mollel G J, Sigalla G, Wilson L, Dotto E, Glass T, Vanobberghen F, Weisser M

机构信息

Ifakara Health Institute, Ifakara, Tanzania.

St. Francis Regional Referral Hospital, Ifakara, Tanzania.

出版信息

HIV Med. 2025 May;26(5):800-812. doi: 10.1111/hiv.70015. Epub 2025 Mar 25.

DOI:10.1111/hiv.70015

PMID:40134127

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12045149/

Abstract

OBJECTIVE

To assess trends of severe HIV disease (SHD) and mortality/loss to follow-up (LTFU) among children living with HIV in rural Tanzania.

METHODS

Among children aged 0-14 years living with HIV enrolled in the prospective Kilombero & Ulanga Antiretroviral Cohort in January 2005-December 2023, we determined WHO-defined SHD prevalences at enrolment, mortality/LTFU incidence during follow-up using Kaplan-Meier methods, and associated factors using regression models.

RESULTS

At enrolment, among 1089 children [567 (52%) males, 587 (54%) aged <5 years and 530 (49%) with a HIV WHO stage III/IV], 112/332 (34%) had CD4 cell count <200 cells/μL among those aged 5-14 years. In children aged 5-14 years, SHD was diagnosed in 265/502 (53%) with a prevalence of 35-94% declining after 2013. Among children aged <5 years, 374/587 (64%) had SHD with no change over time. Male gender [adjusted odds ratio = 1.45; 95% confidence interval: 1.10-1.90], age <5 years versus older (1.64; 1.13-2.37), hospitalization versus outpatients (6.72; 3.35-13.5), antiretroviral treatment (ART) start within 30 days versus later (2.18; 1.52-3.13), and enrolment during 2013-2016 versus before (2.29; 1.54-3.41) were associated with SHD. After a median follow-up of 3.3 years [interquartile ratio: 0.8-7.8], 130 (12%) children died and 359 (35%) were LTFU. Predictors of mortality/LTFU were SHD [adjusted hazard ratio (aHR) = 1.54; 95% CI: 1.26-1.89], age <5 years versus older (1.28; 1.01-1.66), hospitalization versus outpatients (1.93; 1.42-2.63), living ≥50 km versus ≤1 km away (1.72; 1.37-2.16) and delayed ART initiation versus within 30 days (3.40; 2.70-4,27), while enrolment 2017-2023 versus before (0.51; 0.37-0.70) was protective.

CONCLUSIONS

The persisting high prevalence of paediatric SHD and high mortality/LTFU underscores the need for early diagnosis and care.

摘要

目的

评估坦桑尼亚农村地区感染艾滋病毒儿童的严重艾滋病毒疾病（SHD）趋势以及死亡率/失访率（LTFU）。

方法

在2005年1月至2023年12月纳入前瞻性基洛梅罗和乌朗加抗逆转录病毒队列的0至14岁感染艾滋病毒儿童中，我们使用Kaplan-Meier方法确定入组时世卫组织定义的SHD患病率、随访期间的死亡率/LTFU发病率，并使用回归模型确定相关因素。

结果

入组时，在1089名儿童中[567名（52%）为男性，587名（54%）年龄<5岁，530名（49%）处于艾滋病毒世卫组织III/IV期]，5至14岁儿童中有112/332名（34%）的CD4细胞计数<200个/μL。在5至14岁儿童中，265/502名（53%）被诊断为SHD，2013年后患病率从35%降至94%。在年龄<5岁的儿童中，374/587名（64%）患有SHD，随时间无变化。男性[调整后的优势比=1.45；95%置信区间：1.10-1.90]、年龄<5岁与年龄较大者相比（1.64；1.13-2.37）、住院与门诊相比（6.72；3.35-13.5）、抗逆转录病毒治疗（ART）在30天内开始与之后开始相比（2.18；1.52-3.13）以及2013-2016年期间入组与之前相比（2.29；1.54-3.41）与SHD相关。在中位随访3.3年[四分位间距：0.8-7.8]后，130名（12%）儿童死亡，359名（35%）失访。死亡率/LTFU的预测因素为SHD[调整后的风险比（aHR）=1.54；95%置信区间：1.26-1.89]、年龄<5岁与年龄较大者相比（1.28；1.01-1.66）、住院与门诊相比（1.93；1.42-2.63）、居住距离≥50公里与≤1公里相比（1.72；1.37-2.16）以及ART启动延迟与30天内相比（3.40；2.70-4.27），而2017-2023年期间入组与之前相比（0.51；0.37-0.70）具有保护作用。