Long-Term Outcomes in Adolescents Perinatally Infected with HIV-1 and Followed Up since Birth in the French Perinatal Cohort (EPF/ANRS CO10)
Long-Term Outcomes in Adolescents Perinatally Infected with HIV-1 and Followed Up since Birth in the French Perinatal Cohort (EPF/ANRS CO10)
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DOI：
10.1086/653674
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发表时间：
2010-07-15
影响因子：
11.8
通讯作者：
Warszawski, J.
中科院分区：
文献类型：
--
作者：
Dollfus, C.;Le Chenadec, J.;Warszawski, J.
背景。越来越多围产期感染人类免疫缺陷病毒（艾滋病毒）的儿童进入青春期，这主要是由于过去10年来治疗的进步，但对他们目前的健康状况知之甚少。我们在这里描述的生活条件和临床和免疫病毒学结果的最后评估在这一代先锋青少年谁出生之前引入预防垂直传播和感染诊断时，治疗方案是有限的。符合条件的人群包括1993年12月之前出生的hiv -1感染儿童，并在出生时被纳入法国全国围产期队列（EPF/ANRS CO10）。在348名符合条件的儿童中，210名（60%；中位年龄为15岁）仍然存活并定期随访。目前的治疗是高活性抗逆转录病毒治疗（HAART），占77%，2核苷类似物占5.0%；16%的人停止了治疗，2%的人从未接受过治疗。CD4细胞计数中位数为557个细胞/ μ L， 94%的患者超过200个细胞/ μ L。中位病毒载量为200拷贝/mL。43%的青少年和54.5%接受HAART治疗的青少年无法检测到病毒载量。身高、体重和身体质量指数的中位数与法国年龄参考值相似，学习成绩与全国统计数据相似。较好的免疫状态与较年轻和较早开始HAART有关。无法检测到的病毒载量与母亲的地理来源和目前的haart有关。考虑到这些患者生命早期可用的治疗选择有限，以及在青春期坚持治疗所带来的挑战，这些人群的长期结果是令人鼓舞的。
Background. Increasing numbers of children perinatally infected with human immunodeficiency virus (HIV) are reaching adolescence, largely because of advances in treatment over the past 10 years, but little is known about their current health status. We describe here the living conditions and clinical and immunovirologic outcomes at last evaluation among this pioneering generation of adolescents who were born before the introduction of prophylaxis for vertical transmission and whose infections were diagnosed at a time when treatment options were limited.Methods. The eligible population consisted of HIV-1-infected children who were born before December 1993 and who were included at birth in the prospective national French Perinatal Cohort (EPF/ANRS CO10).Results. Of the 348 eligible children, 210 (60%; median age, 15 years) were still alive and regularly followed up. Current treatment was highly active antiretroviral therapy (HAART) in 77% and 2 nucleoside analogues in 5.0%; 16% had stopped treatment, and 2% had never been treated. The median CD4 cell count was 557 cells/mu L, and 200 cells/mu L was exceeded in 94% of patients. The median viral load was 200 copies/mL. Viral load was undetectable in 43% of the adolescents and in 54.5% of those receiving HAART. Median height, weight, and body mass index were similar to French reference values for age, and school achievement was similar to nationwide statistics. Better immunologic status was associated with being younger and with having begun HAART earlier. Undetectable viral load was associated with maternal geographic origin and current HAART.Conclusions. Given the limited therapeutic options available during the early years of these patients' lives and the challenge presented by treatment adherence during adolescence, the long-term outcomes among this population are encouraging.