Mortality in HIV-infected and uninfected children of HIV-infected and uninfected mothers in rural Uganda
Mortality in HIV-infected and uninfected children of HIV-infected and uninfected mothers in rural Uganda
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DOI：
10.1097/01.qai.0000188122.15493.0a
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发表时间：
2006-04-01
影响因子：
3.6
通讯作者：
Gray, R
中科院分区：
文献类型：
--
作者：
Brahmbhatt, H;Kigozi, G;Gray, R
目标：估计2年的死亡率在HIV-1感染和未感染的婴儿出生的HIV+和HIV- mothers.Methods：数据来自一项前瞻性研究，在农村Rakai区，乌干达。在产后1 - 6周和母乳喂养期间评估婴儿的艾滋病毒状况（通过聚合酶链反应测定），并在产后访视时测量母亲的艾滋病毒载量和CD 4水平。采用多变量考克斯比例风险模型和Kaplan-Meier生存分析评估母婴HIV状态和病毒载量四分位数的婴儿生存率。结果：4604例孕妇中HIV阳性率为16.9%，儿童感染率为20.9%。感染艾滋病毒的婴儿的中位生存期为23个月。两年期儿童死亡率为128/1000名艾滋病毒阴性母亲所生儿童，165.5/1000名艾滋病毒阳性母亲所生未感染儿童，540.1/1000名艾滋病毒感染儿童（P < 0.0001）。与HIV阴性母亲的子女相比，母亲为HIV阳性的儿童死亡风险为2.04（P < 0.001），婴儿同时感染HIV的儿童死亡风险为3.78（P < 0.001）。在校正模型中，婴儿和母亲中log（10）HIV病毒载量的最高四分位数与儿童死亡风险显著增加相关（风险比[HR]分别为8.54和2.50）。母亲CD 4计数< 200个细胞/mL也是儿童死亡率的重要预测因素（HR = 2.61）。67.6%的病毒载量高于中位数的HIV感染儿童在2岁时死亡，需要早期抗逆转录病毒治疗（ART）。结论：超过一半的HIV感染婴儿在不到2岁时死亡。因此，ART可能需要在感染HIV的非洲儿童中更早开始。
Objective: To estimate 2-year mortality rates in HIV-1-infected and uninfected infants born to HIV+ and HIV- mothers.Methods: Data are from a prospective study in rural Rakai District, Uganda. Infant HIV status (determined by polymerase chain reaction) was evaluated at I to 6 weeks postpartum and during breastfeeding, and maternal HIV viral load and CD4 levels were measured at the postpartum visit. Multivariate Cox proportional hazards models and Kaplan-Meier survival analysis were used to assess survival of infants by maternal and infant HIV status and by quartiles of viral load. Log-rank tests were used to test the equality of survival functions.Results: Of the 4604 pregnant women, 16.9% were HIV+, and the proportion of children infected was 20.9%. Median survival of HIV-infected infants was 23 months. Two-year child mortality rates were 128 of 1000 children born to HIV- mothers, 165.5 of 1000 uninfected children born to HIV+ mothers, and 540.1 of 1000 HIV-infected children (P < 0.0001). Compared with children of HIV- mothers, the hazard of child mortality was 2.04 (P < 0.001) if the mother was HIV+ and 3.78 (P < 0.001) if the infant was also infected. In the adjusted model, the highest quartiles of log(10) HIV viral load in infants and mothers were associated with significantly increased hazard of child mortality (hazard ratio [HR] = 8.54 and HR = 2.50, respectively). Maternal CD4 counts < 200 cells/mL were also significant predictors of child mortality (HR = 2.61). A total of 67.6% of HIV-infected children with viral loads above the median died by the age of 2 years and are in need of early antiretroviral therapy (ART).Conclusions: More than half of HIV-infected infants died at less than 2 years of age. Therefore, ART may need to be initiated earlier in HIV-infected African children.