Prospective cohort study of children born to human immunodeficiency virus-infected mothers, 1985 through 1997: trends in the risk of vertical transmission, mortality and acquired immunodeficiency syndrome indicator diseases in the era before highly active
Prospective cohort study of children born to human immunodeficiency virus-infected mothers, 1985 through 1997: trends in the risk of vertical transmission, mortality and acquired immunodeficiency syndrome indicator diseases in the era before highly active
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1985年至1997年对感染人类免疫缺陷病毒的母亲所生儿童的前瞻性队列研究：高度活跃之前的时代垂直传播、死亡率和获得性免疫缺陷综合症指标疾病的风险趋势
DOI：
10.1097/00006454-200007000-00007
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发表时间：
2000
期刊：
影响因子：
--
通讯作者：
Andiman,WA
中科院分区：
文献类型：
--
作者：
Simpson,BJ;Shapiro,ED;Andiman,WA
目标。评估在对感染艾滋病毒的孕妇采用抗逆转录病毒药物治疗和对感染艾滋病毒的儿童采用预防或治疗艾滋病指标疾病的方案后，康涅狄格州南部感染艾滋病毒的儿童中艾滋病毒垂直传播风险的变化以及死亡率和发病率的变化。在一项前瞻性纵向队列研究（第一阶段：1985年12月1日至1990年11月30日）的前5年出生的儿童与在研究的后7年出生的儿童（第二阶段：1990年12月1日至1997年11月30日）的死亡率和艾滋病指标疾病的发病率及其时间趋势进行了比较。在纳入的347名婴儿中，有341名可以确定HIV感染状况；感染44例（12.9%）。垂直传播的风险在第1期出生的儿童中从20.7%下降到第2期出生的儿童中的6.5%（比率比为3.2；95%可信区间为1.7 ~ 6.0；P= 0.0001）。在21名死亡的受感染儿童中，11名（52%）死亡时年龄≤18个月，18名（86%）死亡时年龄≤36个月。在每个时期出生的受感染儿童中，约有四分之一在≤18个月大时死亡。在年龄≤36个月的婴儿中，在第一期出生的婴儿在878个人月的观察中发生了15例死亡，而在第二期出生的婴儿在334个人月的观察中发生了3例死亡（比率比为1.9；95%可信区间为0.5至10.3；P= 0.45）。在44名感染艾滋病毒的儿童中，32名患有一种或多种艾滋病指标疾病（共67次发作），其中73%发生在儿童≤36个月大时。在第2期出生的儿童中，没有人患卡氏肺囊虫肺炎，禽分枝杆菌复合病和消耗综合征的发病率下降，但发病率差异无统计学意义。结论在12年的研究期间，HIV-1垂直传播的风险显著下降，具有统计学意义。相比之下，尽管感染艾滋病毒的≤36个月的儿童死亡率有下降的趋势，而且与第二阶段相比，第一阶段出生的儿童患艾滋病指标疾病的总体比率有所变化，但差异在统计上并不显著。
Objectives.To assess changes in the risk of vertical transmission of HIV and changes in both mortality and morbidity among children in southern Connecticut with HIV infection after the introduction of treatment of HIV-infected pregnant women with antiretroviral drugs and of regimens to prevent or to treat AIDS indicator diseases in infected children.Methods.The risk of vertical transmission of HIV, the rates of death and of AIDS indicator diseases and temporal trends in each were determined for children born in the first 5 years of a prospective, longitudinal cohort study (Period 1: December 1, 1985, through November 30, 1990) compared with those for children born during the latter 7 years of the study (Period 2: December 1, 1990, through November 30, 1997).Results.Of 347 infants enrolled, HIV infection status could be determined for 341; 44 (12.9%) were infected. The risk of vertical transmission declined from 20.7% among children born in Period 1 to 6.5% among children born in period 2 (rate ratio, 3.2; 95% confidence interval, 1.7 to 6.0; P= 0.0001). Of the 21 infected children who died, 11 (52%) were≤ 18 months of age and 18 (86%) were≤ 36 months of age at the times of death. Approximately one-fourth of infected children born during each period died at≤ 18 months of age. Among those≤ 36 months of age, 15 deaths occurred during 878 person months of observation for those born in Period 1 compared with 3 deaths that occurred during 334 person months for those born in Period 2 (rate ratio, 1.9; 95% confidence interval, 0.5 to 10.3; P= 0.45). Of the 44 children infected with HIV, 32 had one or more AIDS indicator diseases (a total of 67 episodes), 73% of which occurred when the children were≤ 36 months of age. Among children born in Period 2, none developedPneumocystis cariniipneumonia and the rates ofMycobacterium aviumcomplex disease and of wasting syndrome declined, but the differences in rates of disease were not statistically significant.Conclusion.A substantial and statistically significant decline in the risk of vertical transmission of HIV-1 occurred during the 12-year study period. In contrast although there was a trend toward a decrease in mortality among HIV-infected children≤ 36 months of age and changes in the overall rates of AIDS indicator diseases among children born in Period 1 compared with Period 2, the differences were not statistically significant.