Change in HIV-related characteristics of children hospitalised with infectious diseases in Western Cape, South Africa, 2008-2021: a time trend analysis.
Change in HIV-related characteristics of children hospitalised with infectious diseases in Western Cape, South Africa, 2008-2021: a time trend analysis.
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DOI：
10.1002/jia2.26151
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发表时间：
2023-10
影响因子：
6
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随着垂直艾滋病毒传播预防方案的扩大，南非儿童中与艾滋病毒有关的人口概况发生了变化。我们描述了西开普省有传染病住院的3岁(至3岁)≤儿童的艾滋病毒相关特征的时间变化。我们使用常规收集的电子数据来识别在西开普省出生的儿童，这些儿童在2008年至2021年期间有下呼吸道感染、腹泻、脑膜炎和结核性脑膜炎的传染病医院记录。使用关联的母婴唯一标识符来提取怀孕、艾滋病毒相关、实验室、药房和住院数据。我们描述了儿童HIV暴露和获取状态的时间变化，母亲HIV诊断和抗逆转录病毒治疗(ART)开始的时间，婴儿接触母亲ART的时间和时间，以及最接近分娩的母亲CD4和HIV病毒载量。我们使用Logistic回归和多项回归来评估备选方案B+(2008-2013)、备选方案B+(2013-2016)和环球ART时期(2016-2021)之间的特征变化。在52,811名3岁的≤住院儿童中，艾滋病毒携带者的比例从2008年的7.0%下降到2021年的1.1%，而接触艾滋病毒和未感染艾滋病毒的儿童从2008年的14.0%上升到2021年的16.1%，2017年达到18.3%的峰值。在感染艾滋病毒的母亲中(n=9873)，2008年至2021年期间，被诊断为艾滋病毒的母亲和孕前开始抗逆转录病毒治疗的母亲的比例分别从20.2%上升到69.2%和5.8%上升到59.0%。在环球抗逆转录病毒治疗期间住院的儿童接触母体抗逆转录病毒治疗的几率(赔率比：8.41；95%可信区间：7.36-9.61)比选择B+方案之前入院的儿童高8倍。在接触过艾滋病毒但未有CD4感染记录的儿童的母亲中(n=7523)，CD4<；350细胞/μL的比例从2008年的90.6%下降到2021年的27.8%。近年来，在患有传染病住院的儿童中，在围产期感染艾滋病毒的儿童较少，而未感染艾滋病毒的儿童中接触母亲艾滋病毒和抗逆转录病毒药物的比例增加。在评估艾滋病毒流行病对儿童保健服务的影响时，有必要超越儿科艾滋病毒流行率，并考虑到儿童在没有艾滋病毒的儿童中接触艾滋病毒和抗逆转录病毒治疗。
With the scaling up of vertical HIV transmission prevention programmes, the HIV‐related population profile of children in South Africa has shifted. We described temporal changes in HIV‐related characteristics of children, aged ≤3 years (up to the third birthday), with infectious disease hospitalisations across the Western Cape province. We used routinely collected electronic data to identify children born in the Western Cape with infectious disease hospital records for lower respiratory tract infections, diarrhoea, meningitis and tuberculous meningitis, from 2008 to 2021. Linked maternal and child unique identifiers were used to extract pregnancy, HIV‐related, laboratory, pharmacy and hospitalisation data. We described temporal changes in child HIV exposure and acquisition status, timing of maternal HIV diagnosis and antiretroviral therapy (ART) start, infant exposure to maternal ART and timing thereof, and maternal CD4 and HIV viral load closest to delivery. We used logistic and multinomial regression to assess changes in characteristics between the Pre‐Option B+ (2008–2013), Option B+ (2013–2016) and Universal ART periods (2016–2021). Among 52,811 children aged ≤3 years with hospitalisations, the proportion living with HIV dreased from 7.0% (2008) to 1.1% (2021), while those exposed to HIV and uninfected increased from 14.0% (2008) to 16.1% (2021) with a peak of 18.3% in 2017. Among mothers with HIV (n = 9873), the proportion diagnosed with HIV and starting ART before pregnancy increased from 20.2% to 69.2% and 5.8% to 59.0%, respectively, between 2008 and 2021. Children hospitalised during the Universal ART period had eight times higher odds (Odds Ratio: 8.41; 95% CI: 7.36–9.61) of exposure to maternal ART versus children admitted Pre‐Option B+. Among mothers of children exposed to HIV and uninfected with CD4 records (n = 7523), the proportion with CD4 <350 cells/μl decreased from 90.6% (2008) to 27.8% (2021). In recent years, among children hospitalised with infectious diseases, there were fewer children with perinatally acquired HIV, while an increased proportion of those without HIV acquisition are exposed to maternal HIV and ART. There is a need to look beyond paediatric HIV prevalence and consider child exposure to HIV and ART among children without HIV, when assessing the HIV epidemic's impact on child health services.