Quantification of CD4 responses to combined antiretroviral therapy over 5 years among HIV-infected children in Kinshasa, Democratic Republic of Congo.
Quantification of CD4 responses to combined antiretroviral therapy over 5 years among HIV-infected children in Kinshasa, Democratic Republic of Congo.
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DOI：
10.1097/qai.0b013e31825bd9b7
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发表时间：
2012-09-01
期刊：
影响因子：
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通讯作者：
Behets F
中科院分区：
文献类型：
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作者：
Edmonds A;Yotebieng M;Lusiama J;Matumona Y;Kitetele F;Nku D;Napravnik S;Cole SR;Van Rie A;Behets F
抗逆转录病毒联合疗法（cART）对感染艾滋病毒儿童CD4百分比的长期影响尚不完全清楚，来自资源匮乏地区的证据尤其稀少，尽管大多数感染艾滋病毒的儿童生活在这种环境中。我们试图描述这种关系。对2004年12月至2010年5月在刚果民主共和国金沙萨参加艾滋病毒护理和治疗项目的未接受cart治疗儿童的纵向观察数据进行了分析。为了估计cART对CD4百分比的影响，同时考虑到受先前接触cART影响的时间相关混杂因素，使用了边际结构线性平均模型。790名儿童活动2090人年，中位数为31个月；619例（78%）启动cART。在基线时，405名儿童（51%）处于HIV临床3期或4期；528例（67%）有晚期或重度免疫缺陷。与没有cART相比，在cART治疗6个月后，CD4百分比的估计绝对上升为6.8%[95%置信区间（CI）， 4.7%至8.9%]，12个月后为8.6% (95% CI， 7.0%至10.2%)，60个月后为20.5% （95% CI， 16.1%至24.9%）。在基线CD4百分比<15的儿童中，cart介导的CD4百分比增长最慢，但最大。如果在免疫缺陷严重而不是轻度或晚期时开始cART，则世界卫生组织年龄特异性免疫缺陷“不显著”恢复的累积发生率较低。在资源匮乏的环境中，cART增加了艾滋病毒感染儿童的CD4百分比，如先前在美国儿童中指出的那样。基线CD4百分比较低的儿童恢复更为缓慢和持久，支持更早开始儿科cART。
The long-term effects of combined antiretroviral therapy (cART) on CD4 percentage in HIV-infected children are incompletely understood, with evidence from resource-deprived areas particularly scarce even though most children with HIV live in such settings. We sought to describe this relationship. Observational longitudinal data from cART-naive children enrolled between December 2004 and May 2010 into an HIV care and treatment program in Kinshasa, Democratic Republic of Congo were analyzed. To estimate the effect of cART on CD4 percentage while accounting for time-dependent confounders affected by prior exposure to cART, a marginal structural linear mean model was used. Seven hundred ninety children were active for 2090 person-years and a median of 31 months; 619 (78%) initiated cART. At baseline, 405 children (51%) were in HIV clinical stage 3 or 4; 528 (67%) had advanced or severe immunodeficiency. Compared with no cART, the estimated absolute rise in CD4 percentage was 6.8% [95% confidence interval (CI), 4.7% to 8.9%] after 6 months of cART, 8.6% (95% CI, 7.0% to 10.2%) after 12 months, and 20.5% (95% CI, 16.1% to 24.9%) after 60 months. cART-mediated CD4 percentage gains were slowest but greatest among children with baseline CD4 percentage <15. The cumulative incidence of recovery to “not significant” World Health Organization age-specific immunodeficiency was lower if cART was started when immunodeficiency was severe rather than mild or advanced. cART increased CD4 percentages among HIV-infected children in a resource-deprived setting, as previously noted among children in the United States. More gradual and protracted recovery in children with lower baseline CD4 percentages supports earlier initiation of pediatric cART.