Incidence of opportunistic and other infections in HIV-infected children in the HAART era
Incidence of opportunistic and other infections in HIV-infected children in the HAART era
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DOI：
10.1001/jama.296.3.292
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发表时间：
2006-07-19
影响因子：
120.7
通讯作者：
Seage, George R., III
中科院分区：
文献类型：
--
作者：
Gona, Philimon;Van Dyke, Russell B.;Seage, George R., III
背景联合抗逆转录病毒治疗或高效抗逆转录病毒治疗（HAART）已导致人类免疫缺陷病毒（HIV）感染的成人和儿童的机会性感染和其他感染的发病率急剧下降。2004年-在儿科艾滋病临床试验组（PACTG）219 C随访的艾滋病毒感染婴儿、儿童和青少年中;比较HAART时代与HAART前时代的发病率;并测试HAART时代随时间的线性趋势。设计，设置和参与者正在进行的，多中心，一项前瞻性队列研究，旨在检查艾滋病毒感染儿童的长期结局。研究人群包括2000年9月15日至2004年12月31日期间入组的2767名儿童，数据库中的信息输入至2005年8月1日，进行数据分析。前HAART时代的比较人群包括3331名儿童参加了13 PACTG协议，从1988年10月至1998年8月。主要结果措施首次发生的29个目标infection.Results 75%的儿童参加了2000年和2001年，90%的艾滋病毒感染围产期，52%是女孩，59%是黑人。中位年龄为8.2岁（范围：6-13岁）。中位随访时间为3.4年。总体而言，395名（14%）研究参与者中发生了553起特定感染的首次发作。4种最常见的首次感染事件数量及其每100人-年的发生率（IR）为123例细菌性肺炎（IR，2.15; 95%置信区间[CI]，1.79-2.56），77例带状疱疹（IR，1.11; 95% CI，0.88-1.39），57例皮肤真菌感染（IR，0.88; 0.67-1.14），52例口腔念珠菌病（IR，0.93; 95% CI，0.70-1.22）。首次菌血症、耶氏肺孢子虫肺炎、播散性鸟分枝杆菌复合体、淋巴间质性肺炎、全身性真菌感染、巨细胞病毒视网膜炎和结核病的发病率均低于0.50/100人-年。在4个日历年的29例感染中，任何一例的发生率均无统计学显著线性趋势。然而，感染率显着低于HAART前PACTG报告的感染率。HAART前的IR如下：细菌性肺炎，IR，11.1; 95% CI，10.3-12.0;菌血症，IR，3.3; 95% CI，2.9-3.8;带状疱疹，IR，2.9; 95% CI，2.6-3.3;播散性鸟支原体复合体，IR，1.8; 95% CI，1.5-2.1;耶氏疟原虫，IR，1.3; 95% CI，1.1-1.6;口腔念珠菌病，IR，1.2; 95% CI，1.0-1.5;巨细胞病毒视网膜炎，IR，0.5; 95% CI，0.3-0.6;和结核病，IR，0.2; 95%CI，0.1- 0.4。结论HAART时代儿童肺部感染及相关感染少见，感染率继续低于HAART之前的报告。持续监测对于评估HAART对儿童机会性感染和其他相关感染发生的长期影响非常重要。
Context Combination anti-retroviral therapy or highly active antiretroviral therapy (HAART) has resulted in a dramatic decline in the incidence of opportunistic and other infections in human immunodeficiency virus (HIV)-infected adults and children.Objectives To estimate the incidence of 29 targeted opportunistic and other infections occurring in the era of HAART-between January 1, 2001, and December 31, 2004-in HIV-infected infants, children, and adolescents followed up in Pediatric AIDS Clinical Trials Group (PACTG) 219C; to compare incidence rates in the HAART era to those of the pre-HAART era; and to test for linear trends over time in the HAART era.Design, Setting, and Participants Ongoing, multicenter, prospective cohort study designed to examine long-term outcomes in HIV-infected children. The study population included 2767 children enrolled between September 15, 2000, and December 31, 2004, with information entered in the database up to August 1, 2005, when data analysis was conducted. The pre-HAART era comparison population included 3331 children enrolled in 13 PACTG protocols from October 1988 to August 1998.Main Outcome Measures First occurrence of each of the 29 targeted infections.Results Seventy-five percent of the children were enrolled in 2000 and 2001, 90% acquired HIV perinatally, 52% were girls, and 59% were black. The median age was 8.2 years (range, 6-13 years). The median duration of follow-up was 3.4 years. Overall, 553 first episodes of a specific infection occurred among 395 (14%) of the study participants. The number of events for the 4 most common first-time infections and their incidence rates (IRs) per 100 person-years were 123 bacterial pneumonia (IR, 2.15; 95% confidence interval [CI], 1.79-2.56), 77 herpes zoster (IR, 1.11; 95% CI, 0.88-1.39), 57 dermatophyte infections (IR, 0.88; 0.67-1.14), and 52 oral candidiasis (IR, 0.93; 95% CI, 0.70-1.22). Incidence rates of first bacteremia, Pneumocystis jeroveci pneumonia, disseminated Mycobacterium avium complex, lymphoid interstitial pneumonitis, systemic fungal infection, cytomegalovirus retinitis, and tuberculosis were all less than 0.50 per 100 person-years. There were no statistically significant linear trends in incidence for any of the 29 infections over the 4 calendar years. However, infection rates were significantly lower than those reported in the PACTG in the pre-HAART era. The pre-HAART IRs were as follows: for bacterial pneumonia, IR, 11.1; 95% CI, 10.3-12.0; bacteremia, IR, 3.3; 95% CI, 2.9-3.8; herpes zoster, IR, 2.9; 95% CI, 2.6-3.3; disseminated M avium complex, IR, 1.8; 95% CI, 1.5-2.1; P jeroveci, IR, 1.3; 95% CI, 1.1-1.6; oral candidiasis, IR, 1.2; 95% CI, 1.0-1.5; cytomegalovirus retinitis, IR, 0.5; 95% CI, 0.3-0.6; and tuberculosis, IR, 0.2; 95% CI, 0.1-0.4.Conclusions Opportunistic infections and other related infections are uncommon in children in the HAART era, and infection rates continue to be lower than those reported in the pre-HAART era. Continued surveillance is important to assess the long-term effect of HAART on the occurrence of opportunistic and other related infections in children.