垂直感染的无症状或轻症未治疗儿童的HIV-1病毒载量和CD4细胞计数。欧洲儿科艾滋病治疗网络（PENTA）。

HIV-1 viral load and CD4 cell count in untreated children with vertically acquired asymptomatic or mild disease. Paediatric European Network for Treatment of AIDS (PENTA).

出版信息

AIDS. 1998 Mar 5;12(4):F1-8.

PMID:9520161

Abstract

BACKGROUND

Plasma HIV-1 RNA levels are high in vertically infected infants. Information in older children is limited, particularly in those who have not received antiretroviral therapy.

OBJECTIVES

To describe the relationships between HIV-1 RNA, age and CD4 cell count in untreated vertically infected children.

DESIGN

HIV-1 RNA was measured in 70 children [median age, 3.5 years (range, 0.4-11.9 years); median CD4 cell count, 881 x 10(6)/l (interquartile range, 576-1347 x 10(6) cells/l)] enrolled in a randomized placebo-controlled trial comparing immediate with deferred zidovudine in asymptomatic or mildly symptomatic vertically infected children (PENTA-1 trial). Short-term variability was assessed by comparing HIV-1 RNA at -2 and 0 weeks (prior to randomization). The relationship between age and HIV-1 RNA, and CD4 cell count was analysed using data from all children prior to randomization and sequential samples from 35 remaining on placebo for up to 105 weeks, by fitting mixed linear models.

RESULTS

The within-individual SD in viral load was 0.26 log10 copies/ml. The median plasma HIV-1 RNA at enrollment was 4.61 log10 (range, 2.3-6.56 log10 copies/ml), significantly higher in children aged < or = 2 years (median, 5.23 log10 copies/ml) than in those aged > 2 years (4.51 log10 copies/ml; P < 0.0001). Mean HIV-1 RNA fell by 0.38 log10 copies/ml per year up to 2 years of age, by 0.21 log10 copies/ml per year from 2 to 4 years of age, and by 0.03 log10 copies/ml per year from 4 to 6 years of age reaching a nadir of 4.25 log10 copies/ml at 6 years. Mean log10 CD4 cell count declined steadily with age and was not significantly correlated with HIV-1 RNA, although there was some evidence that the rate of log10 CD4 cell decline was negatively correlated with the initial rate of HIV-1 RNA decline. No mutations associated with resistance to zidovudine were observed.

CONCLUSIONS

Age is a key factor in the interpretation of both viral load and CD4 cell count in vertically infected children.

摘要

背景

垂直感染的婴儿血浆中HIV-1 RNA水平较高。关于大龄儿童的相关信息有限，尤其是那些未接受抗逆转录病毒治疗的儿童。

目的

描述未经治疗的垂直感染儿童中HIV-1 RNA、年龄和CD4细胞计数之间的关系。

设计

在一项随机安慰剂对照试验中，对70名儿童[中位年龄3.5岁（范围0.4 - 11.9岁）；中位CD4细胞计数881×10⁶/l（四分位间距576 - 1347×10⁶细胞/l）]进行了HIV-1 RNA检测，该试验比较了无症状或症状轻微的垂直感染儿童立即使用齐多夫定与延迟使用齐多夫定的效果（PENTA-1试验）。通过比较随机分组前 -2周和0周时的HIV-1 RNA评估短期变异性。使用随机分组前所有儿童的数据以及35名继续使用安慰剂长达105周的儿童的序贯样本，通过拟合混合线性模型分析年龄与HIV-1 RNA以及CD4细胞计数之间的关系。

结果

病毒载量的个体内标准差为0.26 log₁₀拷贝/ml。入组时血浆HIV-1 RNA的中位数为4.61 log₁₀（范围2.3 - 6.56 log₁₀拷贝/ml），≤2岁儿童（中位数5.23 log₁₀拷贝/ml）显著高于>2岁儿童（4.51 log₁₀拷贝/ml；P<0.0001）。在2岁之前，HIV-1 RNA平均每年下降0.38 log₁₀拷贝/ml，2至4岁时每年下降0.21 log₁₀拷贝/ml，4至6岁时每年下降0.03 log₁₀拷贝/ml，6岁时达到最低点4.25 log₁₀拷贝/ml。平均log₁₀CD⁴细胞计数随年龄稳步下降，与HIV-1 RNA无显著相关性，尽管有一些证据表明log₁₀CD⁴细胞下降速率与HIV-1 RNA初始下降速率呈负相关。未观察到与齐多夫定耐药相关的突变。