Kotloff K L, Johnson J P, Nair P, Hickman D, Lippincott P, Wilson P D, Clemens J D
Division of Infectious Diseases, University of Maryland School of Medicine, Baltimore 21201.
JAMA. 1994 Feb 9;271(6):448-52.
To determine the incidence, cause, and patterns of diarrhea during the first 2 years of life among infants infected perinatally with the human immunodeficiency virus (HIV).
A cohort study in which infants were enrolled shortly after birth and followed up longitudinally using biweekly surveillance for the occurrence of diarrhea. Stool specimens collected at the onset of diarrhea were evaluated for enteropathogens. Infants who were infected with HIV were compared with uninfected infants.
Infants born to HIV-infected women at the University of Maryland Hospital, Baltimore, were recruited at 0 to 3 months of age. This analysis included 58 infants enrolled in the cohort and followed up at least 15 months (unless death intervened) whose HIV status was established (18 HIV-infected infants and 40 HIV-uninfected infants).
The overall incidence of diarrhea in HIV-infected infants was 3.2 episodes per 12 child-months compared with 1.5 episodes per 12 child-months among HIV-uninfected infants (incidence density ratio, 2.2; P < .05). An enteropathogen was identified in stool specimens collected during 20% of diarrheal episodes occurring in HIV-infected infants and during 25% of diarrheal episodes occurring in HIV-uninfected infants. Episodes that persisted for 14 days or longer were significantly more common among HIV-infected infants. The peak incidence of diarrhea occurred at 0 to 5 months of age for HIV-infected infants compared with 6 to 11 months for HIV-uninfected infants. Early onset of diarrhea (< 6 months old) in HIV-infected infants was associated with the later development of persistent episodes of diarrhea, and those with persistent episodes had more severe HIV infection, characterized by a significantly higher frequency of opportunistic infections and lower CD4+ T-lymphocyte counts by 1 year of age.
Both acute and persistent episodes of diarrhea are major sources of morbidity in HIV-infected infants. Moreover, persistent diarrhea is a marker for rapid progression of HIV disease.
确定围生期感染人类免疫缺陷病毒（HIV）的婴儿在出生后头两年内腹泻的发病率、病因及模式。
一项队列研究，婴儿在出生后不久入组，并通过每两周监测腹泻的发生情况进行纵向随访。对腹泻发作时采集的粪便标本进行肠道病原体评估。将感染HIV的婴儿与未感染婴儿进行比较。
巴尔的摩马里兰大学医院中HIV感染女性所生的婴儿在0至3个月大时被招募。该分析纳入了队列中的58名婴儿，他们至少随访了15个月（除非死亡介入），其HIV状态已确定（18名HIV感染婴儿和40名HIV未感染婴儿）。
HIV感染婴儿腹泻的总体发病率为每12个儿童月3.2次发作，而HIV未感染婴儿为每12个儿童月1.5次发作（发病率密度比为2.2；P < 0.05）。在HIV感染婴儿发生的20%腹泻发作期间采集的粪便标本中鉴定出一种肠道病原体，在HIV未感染婴儿发生的25%腹泻发作期间采集的粪便标本中鉴定出肠道病原体。持续14天或更长时间的发作在HIV感染婴儿中明显更为常见。HIV感染婴儿腹泻的发病高峰出现在0至5个月龄，而HIV未感染婴儿为6至11个月龄。HIV感染婴儿腹泻的早期发作（<6个月龄）与腹泻持续发作的后期发展相关，而持续发作的婴儿HIV感染更严重，其特征是机会性感染频率显著更高，且到1岁时CD4 + T淋巴细胞计数更低。
腹泻的急性发作和持续发作都是HIV感染婴儿发病的主要原因。此外，持续性腹泻是HIV疾病快速进展的一个标志。
