Jeena P M, Coovadia H M, Bhagwanjee S
Department of Pediatrics, Faculty of Medicine, University of Natal, Durban, South Africa.
Crit Care Med. 1996 Jun;24(6):963-7. doi: 10.1097/00003246-199606000-00015.
Intensive care resources are both scarce and costly in South Africa. We set out to ascertain whether human immunodeficiency virus (HIV) status affects the spectrum of disease and the prognosis in children treated in pediatric intensive care units (ICUs).
A prospective, case-controlled study.
The pediatric ICU at Kind Edward VIII Hospital, Durban, South Africa.
HIV-positive cases were classified as "acquired immunodeficiency syndrome," "symptomatic HIV," and "HIV-unrelated diseases." Controls were matched for age, race, gender, severity of disease, and admitting diagnosis.
THe clinician was blinded to the serostatus of patients. Informed consent and Ethics Committee approval were obtained for HIV testing and the study. Outcome measures were the duration of intermittent positive-pressure ventilation and ICU stay, maximum ventilatory requirements, infectious complications, and mortality. There were 11 cases of acquired immune deficiency (AIDS), 24 cases of symptomatic HIV, and 13 cases of HIV-unrelated diseases. Mortality rates for the three groups were as follows: 100% in patients with AIDS compared with 55% in their controls (p<.01); 38% in patients with symptomatic HIV and 46% in controls. Cytomegalovirus and Pneumocystis carinii infections were significantly increased (p<.01, p<.002, respectively) in patients with AIDS as compared with controls. Outcome measures were similar in those patients with symptomatic HIV and those patients with HIV-unrelated diseases, as compared with their respective controls.
Outcome in children with AIDS admitted to the pediatric ICU was significantly worse than the outcome in HIV-uninfected children. However, the number of AIDS patients studied was small. HIV antibody-positive children without AIDS do as well as uninfected controls. Ethics committees in resource-constrained countries may be assisted by such data when making difficult decisions on the admissions of HIV-infected patients to pediatric ICU facilities.
在南非，重症监护资源既稀缺又昂贵。我们着手确定人类免疫缺陷病毒（HIV）状态是否会影响儿科重症监护病房（ICU）中接受治疗的儿童的疾病谱和预后。
一项前瞻性病例对照研究。
南非德班爱德华八世国王医院的儿科ICU。
HIV阳性病例分为“获得性免疫缺陷综合征”、“有症状的HIV感染”和“与HIV无关的疾病”。对照组在年龄、种族、性别、疾病严重程度和入院诊断方面进行匹配。
临床医生对患者的血清学状态不知情。获得了HIV检测和该研究的知情同意书以及伦理委员会的批准。结果指标包括间歇正压通气的持续时间和ICU住院时间、最大通气需求、感染并发症和死亡率。有11例获得性免疫缺陷（AIDS）病例、24例有症状的HIV感染病例和13例与HIV无关的疾病病例。三组的死亡率如下：AIDS患者为100%；相比之下，其对照组为55%（p<0.01）；有症状的HIV感染患者为38%，对照组为46%。与对照组相比，AIDS患者的巨细胞病毒和卡氏肺孢子虫感染显著增加（分别为p<0.01，p<0.002）。与各自的对照组相比，有症状的HIV感染患者和与HIV无关的疾病患者的结果指标相似。
入住儿科ICU的AIDS患儿的预后明显比未感染HIV的儿童差。然而，所研究的AIDS患者数量较少。没有AIDS的HIV抗体阳性儿童的情况与未感染的对照组相同。资源有限国家的伦理委员会在就是否将HIV感染患者收入儿科ICU设施做出艰难决策时，可能会借助此类数据。
