Cognitive function and neurodevelopmental outcomes in HIV-infected Children older than 1 year of age randomized to early versus deferred antiretroviral therapy: the PREDICT neurodevelopmental study.
Cognitive function and neurodevelopmental outcomes in HIV-infected Children older than 1 year of age randomized to early versus deferred antiretroviral therapy: the PREDICT neurodevelopmental study.
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DOI：
10.1097/inf.0b013e31827fb19d
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发表时间：
2013-05
期刊：
影响因子：
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通讯作者：
PREDICT Study Group
中科院分区：
文献类型：
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作者：
Puthanakit T;Ananworanich J;Vonthanak S;Kosalaraksa P;Hansudewechakul R;van der Lugt J;Kerr SJ;Kanjanavanit S;Ngampiyaskul C;Wongsawat J;Luesomboon W;Vibol U;Pruksakaew K;Suwarnlerk T;Apornpong T;Ratanadilok K;Paul R;Mofenson LM;Fox L;Valcour V;Brouwers P;Ruxrungtham K;PREDICT Study Group
我们先前在PREDICT研究中报道了>1岁开始抗逆转录病毒治疗（ART）并随机接受早期与延迟ART的儿童3年无艾滋病生存率相似。我们现在报告神经发育结果。284名年龄在1-12岁之间、CD 4计数在15-24%之间且无AIDS定义疾病的HIV感染的泰国和柬埔寨儿童被随机分为两组，一组在入组时（“早期”，n=139）开始ART，另一组在CD 4计数<15%或发生CDC C事件时（“延迟”，n=145）开始ART。所有受试者均接受了与年龄相适应的神经发育测试，包括Beery视觉运动整合（VMI）、Purdue Pegboard、Color Trails和儿童行为检查表（CBCL）。泰国儿童（n=170）也完成了韦氏智力量表（IQ）和斯坦福大学比奈记忆测试。我们比较了随机组和未感染HIV的儿童（n=319）的第144周的措施。第144周时，中位年龄为9岁，延迟治疗组中有69名（48%）儿童开始接受ART治疗。早期治疗组的CD 4水平较高（33% vs. 24%，p<0.001），病毒抑制儿童的比例较高（91% vs. 40%，p<0.001）。不同治疗组的神经发育评分无差异，在时变多变量模型中，重复评估的治疗组间变化无差异。HIV感染儿童在IQ、Beery VMI、Binet记忆和CBCL方面的表现比未感染儿童差。在未接受抗逆转录病毒治疗但存活超过一岁的HIV感染儿童中，在CD 4 15-24%与< 15%时，接受抗逆转录病毒治疗的神经发育结果相似;但两组儿童的表现都比未感染HIV的儿童差。ART启动对神经发育产生积极影响的机会之窗可能仍然存在于婴儿期。
We previously reported similar AIDS-free survival at 3 years in children who were >1 year old initiating antiretroviral therapy (ART) and randomized to early vs. deferred ART in the PREDICT Study. We now report neurodevelopmental outcomes. 284 HIV-infected Thai and Cambodian children aged 1–12 years with CD4 counts between 15–24% and no AIDS-defining illness were randomized to initiate ART at enrollment (“early”, n=139) or when CD4 count became <15% or a CDC C event developed (“deferred”, n=145). All underwent age-appropriate neurodevelopment testing including Beery Visual Motor Integration (VMI), Purdue Pegboard, Color Trails and Child Behavioral Checklist (CBCL). Thai children (n=170) also completed Wechsler Intelligence Scale (IQ) and Stanford Binet Memory test. We compared week 144 measures by randomized group and to HIV-uninfected children (n=319). At week 144, the median age was 9 years and 69 (48%) of the deferred arm children had initiated ART. The early arm had a higher CD4 (33% vs. 24%, p<0.001) and a greater percentage of children with viral suppression (91% vs. 40%, p<0.001). Neurodevelopmental scores did not differ by arm and there were no differences in changes between arms across repeated assessments in time-varying multivariate models. HIV-infected children performed worse than uninfected children on IQ, Beery VMI, Binet memory and CBCL In HIV-infected children surviving beyond one year of age without ART, neurodevelopmental outcomes were similar with ART initiation at CD4 15–24% vs. < 15%; but both groups performed worse than HIV-uninfected children. The window of opportunity for a positive effect of ART initiation on neurodevelopment may remain in infancy.