Incidence of World Health Organization Stage 3 and 4 Events, Tuberculosis and Mortality in Untreated, HIV-infected Children Enrolling in Care Before 1 Year of Age An IeDEA (International Epidemiologic Databases To Evaluate AIDS) East Africa Regional Analysis
Incidence of World Health Organization Stage 3 and 4 Events, Tuberculosis and Mortality in Untreated, HIV-infected Children Enrolling in Care Before 1 Year of Age An IeDEA (International Epidemiologic Databases To Evaluate AIDS) East Africa Regional Analysis
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DOI：
10.1097/inf.0000000000000223
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发表时间：
2014-06-01
影响因子：
3.6
通讯作者：
Wools-Kaloustian, Kara
中科院分区：
文献类型：
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作者：
Ciaranello, Andrea;Lu, Zhigang;Wools-Kaloustian, Kara
背景：很少有研究报道在开始抗逆转录病毒治疗前世界卫生组织第三阶段(WH03)事件、世界卫生组织第四阶段(WoO4)事件、结核病(TB)和HIV感染婴儿死亡率的CD4%和年龄分层比率。我们根据当地指南，根据当前年龄(或=6个月)和当前CD4%(=25%)，在抗逆转录病毒治疗开始之前，估计最早的临床事件(WHO_3、WHO_4和TB)的发生率。对于没有经历过临床事件的儿童(“背景”死亡率)和经历过包括“急性”死亡(事件发生后30天)的儿童，分别估计了CD4%分层死亡率。结果：在847名儿童中(中位数注册年龄：4.8个月；抗逆转录病毒治疗前的中位数随访：10.8个月；603(71%)例，其中>；=1个CD4%记录)，事件发生率与那些年龄=6个月的儿童相似。对于6个月大的儿童，目前的CD4%与发生WHO4事件的风险相关(P<；0.05)。“背景”死亡率为3.7-8.4/100人年(PY)。“急性”死亡率(发病后30天)在4.7%至29.1/100PY之间变化。结论：在未接受治疗的婴儿中，6个月前和6个月后感染HIV的婴儿中，WHO3、WHO4和TB事件很常见，导致死亡率大幅上升。婴儿艾滋病毒的早期诊断和治疗是至关重要的，无论CD4%如何。
Background: Few studies have reported CD4%- and age-stratified rates of World Health Organization Stage 3 (WHO3) events, World Health Organization Stage 4 (WHO4) events, tuberculosis (TB) and mortality in HIV-infected infants before initiation of antiretroviral therapy.Methods: HIV-infected children enrolled before 1 year of age in the International Epidemiologic Databases to Evaluate AIDS East Africa region (October 1, 2002, to November, 2008) were included. We estimated incidence rates of earliest clinical event (WHO3, WHO4 and TB), before antiretroviral therapy initiation per local guidelines, stratified by current age (< or >= 6 months) and current CD4% (= 25%). CD4%-stratified mortality rates were estimated separately for children who did not experience a clinical event ("background" mortality) and for children who experienced an event, including "acute" mortality (30 days post event).Results: Among 847 children (median enrollment age: 4.8 months; median pre-antiretroviral therapy follow up: 10.8 months; 603 (71%) with >= 1 CD4% recorded), event rates were comparable for those aged = 6 months. Current CD4% was associated with risk of WHO4 events for children = 6 months old (P < 0.05). "Background" mortality was 3.7-8.4/100 person-years (PY). "Acute" mortality (30 days post event) ranged by CD4% from 4.7 to 29.1/100 PY.Conclusions: In treatment-naive, HIV-infected infants, WHO3, WHO4 and TB events were common before and after 6 months of age and led to substantial increases in mortality. Early infant HIV diagnosis and treatment are critically important, regardless of CD4%.