Effectiveness of pediatric antiretroviral therapy in resource-limited settings: a systematic review and meta-analysis.
Effectiveness of pediatric antiretroviral therapy in resource-limited settings: a systematic review and meta-analysis.
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DOI：
10.1086/648079
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发表时间：
2009-12-15
期刊：
影响因子：
--
通讯作者：
Walensky RP
中科院分区：
文献类型：
--
作者：
Ciaranello AL;Chang Y;Margulis AV;Bernstein A;Bassett IV;Losina E;Walensky RP
最近报道了在资源有限的环境中感染艾滋病毒的儿童对抗逆转录病毒治疗的反应，但结果各不相同。我们试图得出在资源有限的环境中开始抗逆转录病毒治疗的儿童12个月病毒学抑制率（HIV RNA<400拷贝/ml）和CD4细胞百分比增加（ΔCD4%）的汇总估计。我们使用Medline、EMBASE和LILACS电子数据库和Cochrane临床试验注册，对treatment-naïve儿童（0-17岁）的HIV RNA和CD4结果的已发表报告进行了系统回顾和荟萃分析。在接受ART治疗12个月后，RNA<400/ml和ΔCD4%报告比例的汇总估计使用患者水平估计和固定效应和随机效应模型得出。为了接近“意向治疗”分析，在敏感性分析中，假设缺少12个月数据的儿童RNA>400/ml或ΔCD4%为零。使用ART治疗12个月后的患者水平估计，病毒学抑制的合并比例为70% (95%CI: 67-73)；合并ΔCD4%为13.7% （95%CI: 11.8-15.7）。固定效应和随机效应模型的结果相似。在近似的“意向治疗”分析中，病毒学抑制的合并估计值降至53% (95%CI: 50-55)， ΔCD4%为8.5% （95%CI: 5.5-11.4）。在资源有限的环境中，艾滋病毒感染儿童在接受抗逆转录病毒治疗12个月后的病毒学和免疫学益处的汇总估计与在发达环境中观察到的儿童相当。报告数据缺失原因的一致性将有助于在资源有限的情况下评估抗逆转录病毒治疗的结果。
Responses to ART among HIV-infected children in resource-limited settings have recently been reported, but outcomes vary. We sought to derive pooled estimates of the 12-month rate of virologic suppression (HIV RNA<400 copies/ml) and gain in CD4 cell percentage (ΔCD4%) for children initiating ART in resource-limited settings. We conducted a systematic review and meta-analysis of published reports of HIV RNA and CD4 outcomes for treatment-naïve children (0–17 years) using the Medline, EMBASE, and LILACS electronic databases and the Cochrane Clinical Trials Register. Pooled estimates of the reported proportion with RNA<400/ml and ΔCD4% after 12 months of ART were derived using patient-level estimates and fixed- and random-effects models. To approximate “intention-to-treat” analyses, in sensitivity analyses, children with missing 12-month data were assumed to have RNA>400/ml or ΔCD4% of zero. Using patient-level estimates after 12-months of ART, the pooled proportion with virologic suppression was 70% (95%CI: 67–73); the pooled ΔCD4% was 13.7% (95%CI: 11.8–15.7). Results from the fixed- and random-effects models were similar. In approximated “intention-to-treat” analyses, the pooled estimates fell to 53% with virologic suppression (95%CI: 50–55) and to a ΔCD4% of 8.5% (95%CI: 5.5–11.4). Pooled estimates of reported virologic and immunologic benefits after 12 months of ART among HIV-infected children in resource-limited settings are comparable to those observed among children in developed settings. Consistency in reporting on reasons for missing data will aid in the evaluation of ART outcomes in resource-limited settings.
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影响因子：
3.8
作者：
Fassinou, P;Elenga, N;Msellati, P
通讯作者：
Msellati, P
影响因子：
3.8
作者：
Ble, Claudio;Floridia, Marco;Mazzotta, Francesco
通讯作者：
Mazzotta, Francesco
影响因子：
120.7
作者：
Gona, Philimon;Van Dyke, Russell B.;Seage, George R., III
通讯作者：
Seage, George R., III
影响因子：
11.8
作者：
Ivers, LC;Kendrick, D;Doucette, K
通讯作者：
Doucette, K
DOI：
10.1097/qai.0b013e31814278c0
发表时间：
2007-10-01
影响因子：
3.6
作者：
Kamya, Moses R.;Mayanja-Kizza, Harriet;Kekitiinwa, Adeodata
通讯作者：
Kekitiinwa, Adeodata