Causes of Death in Pediatric Patients Vertically Infected by the Human Immunodeficiency Virus Type 1 in Madrid, Spain, From 1982 to Mid-2009
Causes of Death in Pediatric Patients Vertically Infected by the Human Immunodeficiency Virus Type 1 in Madrid, Spain, From 1982 to Mid-2009
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DOI：
10.1097/inf.0b013e318211399f
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发表时间：
2011-06-01
影响因子：
3.6
通讯作者：
Angeles Munoz-Fernandez, Ma
中科院分区：
文献类型：
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作者：
Palladino, Claudia;Climent, Francisco J.;Angeles Munoz-Fernandez, Ma
背景：有效的治疗方法增加了人类免疫缺陷病毒（HIV）感染的儿科患者的预期寿命。我们调查了死亡的根本原因，死亡率和获得性免疫缺陷综合征（AIDS）率在艾滋病毒感染的儿科患者在马德里，Spain.Methods：我们研究了一个多中心队列的478例艾滋病毒感染的儿科患者在马德里。在日历期间（CP）：前HAART（高效抗逆转录病毒疗法）（CP 1：1982-1996）和后HAART时代（CP 2：1997-2009），分析死亡率和艾滋病发病率，死亡原因，CD 4（+）T细胞和HIV RNA。中位死亡年龄增加（CP 1：3.2岁[1.0-6.3] vs. CP 2：7.7岁[3.1-11.4]; P < 0.01）。CP之间的死亡率和艾滋病发生率分别降低了10.6倍（95%置信区间[CI]：6.9-16.7）和6.9倍（95% CI：5.0-9.6）。然而，在CP 2晚期，死亡率比年龄相似的一般人群高10.4倍（95% CI：5.8-18.8; P < 0.001）。总共报告了169个死亡原因。151例患者中有16例（10.6%）报告了多种原因。在81.1%（137/169）的病例中，病因为AIDS，11.8%（20/169）与HIV有关，7.1%（12/169）与HIV无关。感染是主要原因（60.8%，101/166）;从1999年到2007年，感染导致的死亡风险是年龄相似的普通人群的115.9倍（95%CI：42.0-265.8; P < 0.001）。66.9%（101/151）的患者报告合并症。死亡时HIV-1 RNA中位数降低（CP 1：5.9 [5.0-6.3]; CP 2：5.3 [4.2-5.8]; P < 0.01）。结论：尽管死亡率和艾滋病率下降，但监测所有死亡原因是重要的，因为延长生存期可能使潜在的合并症变得更具有临床相关性。
Background: Effective therapies have increased life expectancy of human immunodeficiency virus (HIV)-infected pediatric patients. We investigated the underlying causes of death, mortality, and acquired immune deficiency syndrome (AIDS) rates in HIV-infected pediatric patients in Madrid, Spain.Methods: We studied a multicenter cohort of 478 HIV-infected pediatric patients in Madrid. Mortality and AIDS incidence rates, causes of death, CD4(+) T-cell, and HIV RNA were analyzed during calendar periods (CPs): pre-HAART (highly active antiretroviral therapy) (CP1: 1982-1996) and post-HAART era (CP2: 1997-2009).Results: During 5690 person-years of follow-up 157 (32.8%) deaths occurred. Median age at death increased (CP1: 3.2 years [1.0-6.3] vs. CP2: 7.7 years [3.1-11.4]; P < 0.01). Mortality and AIDS rates decreased 10.6-fold (95% confidence intervals [CI] : 6.9-16.7) and 6.9-fold (95% CI: 5.0-9.6), respectively, between CPs. Nevertheless, mortality was 10.4-fold (95% CI: 5.8-18.8; P < 0.001) higher than in age-similar general population in late-CP2. In all, 169 causes of death were reported. Multiple causes were reported in 16 of 151 (10.6%) patients. In 81.1% (137/169), the causes were AIDS-defining, 11.8% (20/169) HIV-related, and 7.1% (12/169) non-HIV-related. Infections were the leading causes (60.8%, 101/166); from 1999 to 2007 the risk of death from infections was 115.9 times (95% CI: 42.0-265.8; P < 0.001) higher than in the age-similar general population. Comorbidity was reported in 66.9% (101/151) of patients. Median HIV-1 RNA at death decreased (CP1: 5.9 [5.0-6.3]; CP2: 5.3 [4.2-5.8]; P < 0.01).Conclusions: Despite decline in mortality and AIDS rates, it is important to monitor all causes of death as prolonged survival might allow underlying comorbidity to become more clinically relevant.