Johann-Liang R, Cervia J S, Noel G J
Division of Pediatric Infectious Diseases and Immunology, The New York Hospital-Cornell Medical Center, NY 10021, USA.
Pediatr Infect Dis J. 1997 Dec;16(12):1145-50. doi: 10.1097/00006454-199712000-00009.
To describe the changes in the characteristics of human immunodeficiency virus (HIV)-related deaths in children with perinatally acquired infection.
A retrospective review of all deaths that occurred in HIV-infected children managed at The New York Hospital-Program for Children with AIDS during a 7-year period from January, 1990, to December, 1996. Differences in the characteristics at death between 15 children who died in 1990 and 10 children who died in 1996 were analyzed.
Fifty-eight deaths in our cohort of HIV-infected children were identified during the 7-year period. The mean age at death was 4.43 years. Sixty-nine percent of children were black, 55% were male and 94% were receiving Medicaid. The mean weight/age Z score was -3.9 and the mean CD4 index was 0.067 with 65% having <50 CD4 cells/microl at the time of death (TOD). The most common organ/organ systems to be involved at the TOD were lung (78%) and central nervous system (61%). Mycobacterium avium complex (MAC) was the most common isolate at the TOD (26%) followed by Pneumocystis carinii (20%) and Pseudomonas aeruginosa (17%). The leading non-infectious cause of death was cardiac failure (9%). Comparison of the characteristics at the TOD between 1990 and 1996 revealed significant differences in mean age (2.1 vs. 9.2 years, P < 0.0001), mean CD4 count index (0.18 vs. 0.02, P < 0.03), mean number of organ/organ system involvement (3.9 vs. 5.9, P < 0.05), percent receiving antiretroviral therapy (33% vs. 70%, P < 0.02), mean number of years receiving antiretroviral therapy (0.88 vs. 3.86 years, P < 0.01), percent receiving P. carinii pneumonia prophylaxis (27% vs. 100%, P < 0.001), percent receiving MAC prophylaxis/therapy (0% vs. 100%, P < 0.0001), and cause of death from P. carinii pneumonia (53% vs. 0%, P < 0.01).
Compared with children who died in 1990, HIV-infected children who died in 1996 were significantly older, more lymphopenic and more likely to have a greater number of organ system involvements and to have received antiviral therapy and antimicrobial prophylaxis. In 1996 no child died of P. carinii pneumonia. In 1996 MAC and P. aeruginosa were the two most important opportunistic infections causing death. These changes in the characteristics at death will warrant review of resources used in treating these children and may be critical in advising parents and care givers about the prognosis of this chronic infection.
描述围生期获得性感染儿童中与人类免疫缺陷病毒（HIV）相关死亡的特征变化。
回顾性分析1990年1月至1996年12月这7年间在纽约医院儿童艾滋病项目中接受治疗的HIV感染儿童的所有死亡病例。分析了1990年死亡的15名儿童和1996年死亡的10名儿童在死亡特征方面的差异。
在这7年间，我们队列中的HIV感染儿童共有58例死亡。平均死亡年龄为4.43岁。69%的儿童为黑人，55%为男性，94%接受医疗补助。平均体重/年龄Z评分为-3.9，平均CD4指数为0.067，65%的儿童在死亡时CD4细胞计数<50个/微升。死亡时最常受累的器官/器官系统是肺（78%）和中枢神经系统（61%）。鸟分枝杆菌复合体（MAC）是死亡时最常见的分离菌（26%），其次是卡氏肺孢子虫（20%）和铜绿假单胞菌（17%）。主要的非感染性死亡原因是心力衰竭（9%）。1990年和1996年死亡时特征的比较显示，平均年龄（2.1岁对9.2岁，P<0.0001）、平均CD4细胞计数指数（0.18对0.02，P<0.03）、平均受累器官/器官系统数量（3.9对5.9，P<0.05）、接受抗逆转录病毒治疗的百分比（33%对70%，P<0.02）、接受抗逆转录病毒治疗的平均年数（0.88年对3.86年，P<0.01）、接受卡氏肺孢子虫肺炎预防的百分比（27%对100%，P<0.001）、接受MAC预防/治疗的百分比（0%对100%，P<0.0001）以及死于卡氏肺孢子虫肺炎的原因（53%对0%，P<0.01）存在显著差异。
与1990年死亡的儿童相比，1996年死亡的HIV感染儿童年龄显著更大、淋巴细胞减少更明显，更有可能出现更多器官系统受累，并且接受了抗病毒治疗和抗菌预防。1996年没有儿童死于卡氏肺孢子虫肺炎。1996年，MAC和铜绿假单胞菌是导致死亡的两个最重要的机会性感染。这些死亡特征的变化将有必要审查用于治疗这些儿童所使用的资源，并且对于向家长和护理人员提供有关这种慢性感染预后的建议可能至关重要。
