Akagi K
Division of Infection, Immunology and Rheumatology, Kanagawa Children's Medical Center, Yokohama, Japan.
Acta Paediatr Jpn. 1998 Oct;40(5):496-502. doi: 10.1111/j.1442-200x.1998.tb01979.x.
According to the Ministry of Health and Welfare AIDS Surveillance Committee's report on vertically transmitted human immunodeficiency virus (HIV) infection, there have been eight children with acquired immune deficiency syndrome (AIDS) and 18 children with HIV infection in Japan, totalling 26 in all as of February 1997. A search of the literature fails to reveal any report that deals with many cases of vertically transmitted HIV infection in Japan.
A primary questionnaire survey was taken of the main medical institutions across the country, followed by a secondary questionnaire survey of physicians and pediatricians who treated the disease. A clinical review was made of 19 children with vertically transmitted HIV infection (including eight AIDS children) according to the 1994 Revised Classification System for HIV Infection in Children.
The mean age at diagnosis was 14.5 months and the diagnosis was made at less than 18 months of life in approximately 70% of infected children. In the mean observation period of 16 months, six of eight AIDS children (75%), and one child of group B died. The mean period of observation for the seven dead children was 7 months, and six of seven children died by 36 months of life. The survival period after the diagnosis of AIDS was 15 months. The diagnosis of HIV infection was made based on the clinical symptoms of all children with AIDS. Of 11 children, six (45%) presented with symptoms of HIV infection by 6 months of life, and 10 of 11 children (91%) presented with symptoms by 26 months of life. The noteworthy clinical findings included hepatomegaly, splenomegaly, recurrent respiratory tract infection, lymph node swelling, oral candidiasis, hepatitis, wasting syndrome, HIV encephalopathy and severe pneumonia. The favored age for the start of complications and the magnitude of decrease in the HIV helper cell count varied with each case of complications of HIV infection (wasting syndrome, HIV encephalopathy) or opportunistic infections (cytomegalovirus infection, Mycobacterium avium complex infection). Anti-HIV drugs (mainly zidovudine) had been used in five of eight children with AIDS and were effective in two long survivors alone.
Children who are diagnosed with HIV infection, based on their clinical symptoms, carry a poor prognosis. In this respect, early diagnosis and progress in anti-HIV therapy are necessary.
根据厚生省艾滋病监测委员会关于垂直传播的人类免疫缺陷病毒（HIV）感染的报告，截至1997年2月，日本有8名儿童患获得性免疫缺陷综合征（AIDS），18名儿童感染HIV，共计26名。检索文献未发现任何有关日本大量垂直传播HIV感染病例的报告。
首先对全国主要医疗机构进行问卷调查，随后对治疗该病的内科医生和儿科医生进行二次问卷调查。根据1994年修订的儿童HIV感染分类系统，对19例垂直传播HIV感染儿童（包括8例AIDS儿童）进行临床评估。
诊断时的平均年龄为14.5个月，约70%的感染儿童在18个月龄前被诊断。在平均16个月的观察期内，8例AIDS儿童中有6例（75%）以及1例B组儿童死亡。7例死亡儿童的平均观察期为7个月，7例儿童中有6例在36个月龄前死亡。AIDS诊断后的生存期为15个月。所有AIDS儿童均根据临床症状诊断为HIV感染。11名儿童中，6例（45%）在6个月龄时出现HIV感染症状，11名儿童中有10例（91%）在26个月龄时出现症状。值得注意的临床发现包括肝肿大、脾肿大、反复呼吸道感染、淋巴结肿大、口腔念珠菌病、肝炎、消瘦综合征、HIV脑病和重症肺炎。HIV感染并发症（消瘦综合征、HIV脑病）或机会性感染（巨细胞病毒感染、鸟分枝杆菌复合群感染）开始出现并发症的常见年龄以及HIV辅助细胞计数下降的幅度因病例而异。8例AIDS儿童中有5例使用了抗HIV药物（主要是齐多夫定），仅对2例长期存活者有效。
根据临床症状诊断为HIV感染的儿童预后较差。在这方面，早期诊断和抗HIV治疗的进展是必要的。
