12-month outcomes of HIV-infected infants identified at birth at one maternity site in Johannesburg, South Africa: an observational cohort study
12-month outcomes of HIV-infected infants identified at birth at one maternity site in Johannesburg, South Africa: an observational cohort study
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DOI：
10.1016/s2352-3018(18)30251-0
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发表时间：
2018-12-01
期刊：
影响因子：
16.1
通讯作者：
Kuhn, Louise
中科院分区：
文献类型：
--
作者：
Technau, Karl-Gunter;Strehlau, Renate;Kuhn, Louise
背景在出生时被诊断为HIV感染后开始抗逆转录病毒治疗(ART)是儿科HIV护理的一个新兴领域。我们介绍了南非约翰内斯堡Rahima Moosa母婴医院出生时发现的HIV感染婴儿的结果。方法从2013年9月(ERA1)开始，只有高危HIV暴露婴儿在出生时接受诊断HIV PCR检测。从2014年6月(第二代)开始，所有接触艾滋病毒的婴儿都接受了基于实验室的诊断性PCR检测。从2014年10月(ERA 3)开始，在工作人员允许的情况下，还进行了护理点(POC)诊断性PCR测试。我们描述了在这些地区发现的艾滋病毒感染婴儿的开始抗逆转录病毒治疗的时间、死亡率、保留护理和病毒抑制。结果我们测试了5449名在2013年9月1日至2016年6月30日期间出生的感染艾滋病毒的婴儿。88名确诊为HIV感染的新生儿被纳入研究，其中86人(98%)开始抗逆转录病毒治疗。ART开始时的中位年龄从ERA 1的9天(IQR 6-25)和ERA 3的2天(1-8)下降到2天(1-8)。在ERA 3中，接受POC检测的新生儿在出生后48小时内开始ART的人数(29例[83%]；中位数1天[IQR 1-2])高于未接受ART检测的新生儿(29例[4%]；中位数6天[5-10天])。各年代12个月内死亡的概率为14%(95%可信区间为8-24)，且不同年代无差异。在72名存活并在现场开始抗逆转录病毒治疗的婴儿中，56名(78%)在12个月时被保留下来。在保留在护理中心的56名婴儿中，40名(71%)在12个月时病毒载量低于每毫升400个拷贝，两个时代之间没有差异(p=0.23)。虽然我们队列中的大多数婴儿开始了抗逆转录病毒治疗，但死亡率仍然高得令人无法接受，保留和病毒抑制效果不佳。降低死亡率、改善滞留和病毒抑制仍然是当务之急。版权所有(C)2018爱思唯尔有限公司。保留所有权利。
Background Initiation of antiretroviral therapy (ART) following diagnosis of HIV infection at birth is an emerging area of paediatric HIV care. We present outcomes of HIV-infected infants identified at birth at Rahima Moosa Mother and Child Hospital in Johannesburg, South Africa.Methods From September, 2013 (era 1), only high-risk HIV-exposed infants were offered diagnostic HIV PCR tests at birth. From June, 2014 (era 2), all HIV-exposed infants were offered laboratory-based diagnostic PCR tests. From October, 2014 (era 3), point of care (POC) diagnostic PCR tests were also done if staff availability allowed. We describe time to ART initiation, mortality, retention in care, and viral suppression among the HIV-infected infants identified across these eras.Findings We tested 5449 HIV-exposed infants who were born between Sept 1, 2013, and June 30, 2016. 88 neonates with confirmed HIV infection were identified and included in the study, of which 86 (98%) started ART. Median age at ART initiation decreased from 9 days (IQR 6-25) in eras 1 and 2 to 2 days (1-8) in era 3. In era 3, more neonates who were co-tested with POC testing started ART within 48 h of birth (29 [83%] of 35; median 1 day [IQR 1-2]) than infants who were not co-tested (one [4%] of 29; median 6 days [5-10]). The probability of mortality by 12 months across the eras was 14% (95% CI 8-24) and did not differ by era. Of the 72 infants who survived and initiated ART at the site, 56 (78%) were retained at 12 months. Of the 56 infants retained in care, 40 (71%) had a viral load less than 400 copies per mL at 12 months, with no differences between eras (p=0.23).Interpretation HIV-infected infants can be identified at birth and ART can be initiated within hours to days. Although most infants in our cohort started ART, mortality remained unacceptably high with suboptimal retention and viral suppression. Reducing mortality and improving retention and viral suppression remain urgent priorities. Copyright (C) 2018 Elsevier Ltd. All rights reserved.