Gibb D M, Davison C F, Holland F J, Walters S, Novelli V, Mok J
Department of Epidemiology and Biostatistics, Institute of Child Health, London.
Arch Dis Child. 1994 Mar;70(3):241-4. doi: 10.1136/adc.70.3.241.
In order to review the clinical course, laboratory findings, and outcome of children with vertically acquired HIV infection and Pneumocystis carinii pneumonia, questionnaires were sent to paediatricians in the British Isles who had reported P carinii pneumonia and HIV infection through the British Paediatric Surveillance Unit (BPSU). Paediatric reports from the BPSU are linked to reports of pregnancies in HIV positive women and laboratory reports. P carinii pneumonia was the most frequently reported AIDS indicator disease at AIDS diagnosis, occurring in 22/56 (40%) children born in the British Isles; in a further two children P carinii pneumonia occurred after another AIDS indicator disease. The median age at P carinii pneumonia diagnosis was 4.1 (1.4-27.3) months and in 48% it occurred with other AIDS indicator diseases. Despite intensive treatment the three month survival was only 38%. The nine children surviving P carinii pneumonia subsequently developed further AIDS indicator diseases, in particular HIV encephalopathy and four have since died. P carinii pneumonia was present at AIDS diagnosis in 65% of children developing AIDS in the first year of life and caused 82% of infant deaths. Most children were not known to be at risk of HIV until they presented with P carinii pneumonia. Children with HIV infection develop P carinii pneumonia at an early age and have a poor outcome. Increased awareness of the condition is required to initiate early treatment. Prevention may be a compelling incentive for screening in pregnancy, but further study is required to quantify the risks and benefits of initiating early P carinii pneumonia prophylaxis as well as the impact this might have on life expectancy.
为了回顾垂直感染艾滋病毒且患有卡氏肺孢子虫肺炎儿童的临床病程、实验室检查结果及转归，向不列颠群岛通过英国儿科学监测单位（BPSU）报告过卡氏肺孢子虫肺炎和艾滋病毒感染的儿科医生发放了调查问卷。BPSU的儿科报告与艾滋病毒阳性女性的妊娠报告及实验室报告相关联。卡氏肺孢子虫肺炎是艾滋病诊断时最常报告的艾滋病指征性疾病，在不列颠群岛出生的22/56（40%）名儿童中出现；另有2名儿童在出现另一种艾滋病指征性疾病后发生了卡氏肺孢子虫肺炎。卡氏肺孢子虫肺炎诊断时的中位年龄为4.1（1.4 - 27.3）个月，48%的病例伴有其他艾滋病指征性疾病。尽管进行了强化治疗，但3个月生存率仅为38%。9名卡氏肺孢子虫肺炎存活患儿随后又出现了其他艾滋病指征性疾病，尤其是艾滋病毒脑病，其中4名患儿已死亡。在1岁内患艾滋病的儿童中，65%在艾滋病诊断时就已患有卡氏肺孢子虫肺炎，且82%的婴儿死亡由该病所致。大多数儿童在出现卡氏肺孢子虫肺炎之前并不知晓自己有感染艾滋病毒的风险。感染艾滋病毒的儿童在幼年时就会发生卡氏肺孢子虫肺炎，且转归不佳。需要提高对该病的认识以便尽早开始治疗。预防可能是孕期筛查的一个有力动机，但需要进一步研究来量化早期开始卡氏肺孢子虫肺炎预防的风险和益处，以及这可能对预期寿命产生的影响。
