Priorities for Decreasing Morbidity and Mortality in Children With Advanced HIV Disease
Priorities for Decreasing Morbidity and Mortality in Children With Advanced HIV Disease
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DOI：
10.1093/cid/ciy013
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发表时间：
2018-04-01
影响因子：
11.8
通讯作者：
Ford, Nathan
中科院分区：
文献类型：
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作者：
Frigati, Lisa;Archary, Moherdran;Ford, Nathan
在开始抗逆转录病毒治疗的儿童中，早期死亡率和发病率仍然很高，特别是在撒哈拉以南非洲。许多儿童仍然患有晚期人类免疫缺陷病毒（HIV）疾病。结核病、肺炎和严重细菌感染是感染艾滋病毒儿童住院的主要原因。与患有晚期艾滋病毒疾病的成年人相比，隐球菌病在儿童期并不常见，尽管在婴儿期和青春期有高峰。应实施干预措施，如对有症状的儿童进行结核病筛查，以及异烟肼和复方新诺明预防。有证据表明，对严重营养不良的儿童或入院的艾滋病毒晚期患者迅速（1周内）开始抗逆转录病毒治疗是无益的，应延迟至病情稳定。迫切需要研究严重细菌感染的预防、儿童免疫重建炎症综合征的管理以及降低艾滋病毒感染儿童发病率和死亡率的其他潜在策略。
Early mortality and morbidity remain high in children initiating antiretroviral therapy (ART), especially in sub-Saharan Africa. Many children still present with advanced human immunodeficiency virus (HIV) disease. Tuberculosis, pneumonia, and severe bacterial infections are the main causes of hospital admission in HIV-infected children. In contrast to adults with advanced HIV disease, cryptococcal disease is not common in childhood, although there is a peak in infancy and adolescence. Interventions such as TB screening in symptomatic children, and isoniazid and cotrimoxazole prophylaxis should be implemented. There is evidence suggesting that rapid initiation (within 1 week) of ART in children with severe malnutrition or those with advanced HIV disease admitted to hospital is not beneficial and should be delayed until their condition has been stabilized. Research informing the prevention of severe bacterial infections, the management of pediatric immune reconstitution inflammatory syndrome, and other potential strategies to decrease morbidity and mortality in HIV-infected children are urgently needed.