Carey V J, Yong F H, Frenkel L M, McKinney R E
Channing Laboratory, Harvard Medical School, Boston, Massachusetts 02115, USA.
AIDS. 1998 Jul 30;12(11):1361-9. doi: 10.1097/00002030-199811000-00019.
To describe the natural history of somatic growth in HIV infection by constructing age-specific growth velocity norms and to assess specific prognostic information available using these norms.
Observations on 1338 HIV-infected children aged 3 months to 15 years who participated in one of four US clinical trials of pediatric anti-HIV therapies were pooled; baseline growth velocity data were obtained using the first 6 months of observation for each child.
Distributions of physical growth velocities in HIV-infected children in the Pediatric AIDS Clinical Trials Group were computed. Statistical smoothing of growth histories was employed to derive velocity estimates, and quantile regression analysis of growth velocities was performed to allow comparisons of growth rates in age- and gender-heterogeneous cohorts in the context of HIV infection. The quantile regressions provide corrected z-scores for growth velocity that appropriately compare HIV-infected children with one another for the purpose of distinguishing more from less favorable prognoses.
Consistent deficits in growth velocity amongst HIV-infected children were revealed when compared with the Fels Institute velocity standards. Approximately 33% of height (and 20% of weight) age- and sex-corrected velocity measurements obtained in the first 6 months of clinical trial participation lay beneath the corresponding third percentiles of the Fels reference distributions, which are commonly regarded as critical indicators of growth failure. Proportional hazards regression tests indicated that both weight and height velocity contributed significant information on the risk of death among children with AIDS after adjusting for antiretroviral therapy received, CD4 cell counts, and age at trial enrollment. Comparing subjects who differ in initial weight velocity by one age- and sex-corrected SD, the relative hazard of death was 0.63 (95% confidence interval, 0.55-0.72; P < or = 0.0001) in favor of the child with greater weight velocity, controlling for antiretroviral therapy received, age and CD4 cell count at baseline. The analogous hazard ratio for height velocity was 0.68 (95% confidence interval, 0.57-0.79; P < or = 0.0001).
Suitably normalized growth velocities are informative and inexpensive criteria for pediatric AIDS prognosis; the growth velocity distributions presented will be useful for comparing growth effects of new therapeutic strategies to those of single and combination antiretrovirals employed for maintenance of pediatric HIV infection in the mid-1990s.
通过构建特定年龄的生长速度标准来描述HIV感染中躯体生长的自然史，并评估使用这些标准可获得的特定预后信息。
汇总了参与美国四项儿科抗HIV治疗临床试验之一的1338名3个月至15岁HIV感染儿童的观察结果；使用每个儿童观察的前6个月获得基线生长速度数据。
计算儿科艾滋病临床试验组中HIV感染儿童的身体生长速度分布。采用生长史的统计平滑来得出速度估计值，并对生长速度进行分位数回归分析，以便在HIV感染的背景下比较年龄和性别异质队列中的生长率。分位数回归为生长速度提供校正后的z分数，以便在区分预后优劣时，对HIV感染儿童进行适当的相互比较。
与费尔斯研究所的速度标准相比，HIV感染儿童的生长速度持续存在缺陷。在临床试验参与的前6个月获得的年龄和性别校正后的速度测量中，约33%的身高（和20%的体重）低于费尔斯参考分布相应的第三百分位数，这些通常被视为生长失败的关键指标。比例风险回归测试表明，在调整接受的抗逆转录病毒治疗、CD4细胞计数和试验入组年龄后，体重和身高速度均为艾滋病儿童死亡风险提供了重要信息。比较初始体重速度相差一个年龄和性别校正标准差的受试者，在控制接受的抗逆转录病毒治疗、基线年龄和CD4细胞计数的情况下，体重速度较快的儿童的相对死亡风险为0.63（95%置信区间，0.55 - 0.72；P≤0.0001）。身高速度的类似风险比为0.68（95%置信区间，0.57 - 0.79；P≤0.0001）。
适当标准化的生长速度是儿科艾滋病预后的信息丰富且成本低廉的标准；所呈现的生长速度分布将有助于比较新治疗策略与20世纪90年代中期用于维持儿科HIV感染的单一和联合抗逆转录病毒药物的生长效果。
