Thea D M, St Louis M E, Atido U, Kanjinga K, Kembo B, Matondo M, Tshiamala T, Kamenga C, Davachi F, Brown C
Division of Geographic Medicine and Infectious Diseases, New England Medical Center, Boston, MA 02111.
N Engl J Med. 1993 Dec 2;329(23):1696-702. doi: 10.1056/NEJM199312023292304.
Persistent diarrhea is a prominent feature of the acquired immunodeficiency syndrome in adults, but its cause and its effect on children with human immunodeficiency virus (HIV) infection are largely unknown, particularly in Africa.
We studied a birth cohort of 429 infants born to HIV-positive or HIV-negative mothers in Zaire to determine the incidence of acute, recurrent (> or = 2 episodes), and persistent (> or = 14 days) diarrhea; outcome; and risk factors.
Of the 238 infants whose mothers were HIV-positive, 53 were infected, 139 were uninfected, and the HIV status of 46 could not be determined. As compared with uninfected infants, infected infants had higher incidence rates for acute diarrhea (170 vs. 100 episodes per 100 child-years, P = 0.003), recurrent diarrhea (21 vs. 11, P = 0.12), and persistent diarrhea (19 vs. 4, P < 0.003). Persistent diarrhea developed in 11 HIV-infected infants; all but 1 died. It also developed in 19 uninfected infants; all but 1 survived. The prevalence of stool pathogens was similar in the two groups. In a multivariate model, persistent diarrhea in an infant was independently associated with symptomatic HIV type 1 infection in the mother (relative hazard, 1.5; P = 0.08). The incidence of persistent diarrhea in the uninfected infants of seropositive mothers was nearly double that in the uninfected infants of seronegative mothers (4.9 vs. 2.7 episodes per 100 child-years), and the risk increased if the mother died (relative hazard, 10.4). Significant growth impairment and severe immunosuppression occurred in the six to eight weeks before the onset of persistent diarrhea.
In Zaire, infants with HIV infection have an 11-fold increased risk of death from diarrhea, largely persistent diarrhea, which is often preceded by recurrent episodes of acute diarrhea, malnutrition, or immunosuppression. Illness and death of the mother increase that risk, even among her uninfected infants.
持续性腹泻是成人获得性免疫缺陷综合征的一个突出特征，但其病因以及对感染人类免疫缺陷病毒（HIV）的儿童的影响在很大程度上尚不清楚，尤其是在非洲。
我们对在扎伊尔出生的429名婴儿进行了一项出生队列研究，这些婴儿的母亲为HIV阳性或阴性，以确定急性、复发性（≥2次发作）和持续性（≥14天）腹泻的发生率、结局及危险因素。
在238名母亲为HIV阳性的婴儿中，53名被感染，139名未被感染，46名婴儿的HIV感染状况无法确定。与未感染婴儿相比，感染婴儿的急性腹泻发生率更高（每100儿童年170次发作对100次发作，P = 0.003），复发性腹泻发生率更高（21次对11次，P = 0.12），持续性腹泻发生率更高（19次对4次，P < 0.003）。11名感染HIV的婴儿出现了持续性腹泻；除1名外全部死亡。19名未感染婴儿也出现了持续性腹泻；除1名外全部存活。两组粪便病原体的流行情况相似。在多变量模型中，婴儿持续性腹泻与母亲有症状的1型HIV感染独立相关（相对危险度，1.5；P = 0.08）。血清阳性母亲的未感染婴儿中持续性腹泻的发生率几乎是血清阴性母亲的未感染婴儿的两倍（每100儿童年4.9次发作对2.7次发作），如果母亲死亡，风险会增加（相对危险度，10.4）。在持续性腹泻发作前的六至八周出现了显著的生长发育迟缓及严重免疫抑制。
在扎伊尔，感染HIV的婴儿死于腹泻（主要是持续性腹泻）的风险增加了11倍，持续性腹泻之前常伴有急性腹泻、营养不良或免疫抑制的反复发作。母亲的疾病和死亡会增加这种风险，即使在其未感染的婴儿中也是如此。
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