Decline in mortality, AIDS, and hospital admissions in perinatally HIV-1 infected children in the United Kingdom and Ireland
Decline in mortality, AIDS, and hospital admissions in perinatally HIV-1 infected children in the United Kingdom and Ireland
复制标题
DOI：
10.1136/bmj.327.7422.1019
复制
发表时间：
2003-11-01
影响因子：
105.7
通讯作者：
Dunn, DT
中科院分区：
文献类型：
--
作者：
Gibb, DM;Duong, T;Dunn, DT
目的了解儿童HIV感染的人口统计学因素、疾病进展、住院率和抗逆转录病毒治疗的变化。设计通过妊娠期和儿童期艾滋病毒国家研究（NSHPC）和艾滋病毒儿科合作研究（CHIPS）中儿童子集的额外数据进行主动监测。英国和爱尔兰。参与者944名围生期感染HIV-1的儿童接受临床护理。主要结局指标：随着时间的推移，艾滋病进展和死亡、住院率和抗逆转录病毒治疗的使用情况发生变化。结果截至2002年10月，英国和爱尔兰共报告944例围产儿感染艾滋病病毒；黑人628例（67%），老年205例（22%）！在最后10年的随访中，已知有193例（20%）死亡。在国外出生的儿童所占比例从1994-5年的20%上升到2000-2年的60%。1997年以前，死亡率稳定在每100个危险儿童年9.3人，但在2001- 2002年下降到2.0人（趋势P < 0.001）。进展到AIDS的S也有所下降（P < 0.01）。从1997年起，接受三种或四种抗逆转录病毒药物治疗的儿童比例有所增加。入院率下降了80%，但随着更多的儿童接受随访，入院的绝对数量仅下降了26%。结论：自1997年采用三种或四种抗逆转录病毒药物治疗以来，感染艾滋病毒的儿童的死亡率、艾滋病发病率和住院率大幅下降。由于联合王国和爱尔兰受感染儿童的寿命越来越长，在他们进入青春期和成年生活时，越来越需要解决他们的医疗、社会和心理需求。
Objective To describe changes in demographic factors, disease progression, hospital admissions, and use of antiretroviral therapy in children with HIV.Design Active surveillance through the national study of HIV in pregnancy and childhood (NSHPC and additional data from a subset of children in the collaborative HIV paediatric study (CHIPS).Setting United Kingdom and Ireland.Participants 944 children with perinatally acquired HIV-1 under clinical care.Main outcome measures Changes over time in progression to AIDS and death, hospital admission rates, and use of antiretroviral therapy.Results 944 children with perinatally acquired HIV were reported in the United Kingdom and Ireland by October 2002; 628 (67%) were black African, 205 (22%) were aged ! 10 years at last follow up, 193 (20%) are know to have died. The proportion of children presenting who were born abroad increased from 20% in 1994-5 to 60% during 2000-2. Mortality was stable before 1997 at 9.3 per 100 child years at risk but fell to 2.0 in 2001-2 (trend P < 0.001). Progression to AIDS)S also declined (P < 0.00 1). From 1997 onwards the proportion of children on three or four drug antiretroviral therapy increased. Hospital admission rates declined by 80%, but with more children in follow up the absolute number of admissions fell by only 26%.Conclusion In children with HIV infection, mortality, AIDS, and hospital admission rates have declined substantially since the introduction of three or four drug antiretroviral therapy in 1997. As infected children in the United Kingdom and Ireland are living longer, there is an increasing need to address their medical, social, and psychological needs as they enter adolescence and adult life.