Reduction in mortality with availability of antiretroviral therapy for children with perinatal HIV-1 infection
Reduction in mortality with availability of antiretroviral therapy for children with perinatal HIV-1 infection
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DOI：
10.1001/jama.284.2.190
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发表时间：
2000-07-12
影响因子：
120.7
通讯作者：
Pezzotti, P
中科院分区：
文献类型：
--
作者：
de Martino, M;Tovo, PA;Pezzotti, P
背景自从采用联合抗逆转录病毒疗法以来，感染人类免疫缺陷病毒1型（HIV-1）的成人死亡率有所下降。然而，很少有资料是可用于对照试验的设置外，对围产期艾滋病毒感染儿童的生存与抗逆转录病毒therapy.Objective抗逆转录病毒治疗的可用性，降低围产期艾滋病毒感染儿童的死亡率的影响，设计人口为基础，一项多中心纵向研究，涉及意大利儿童HIV感染登记处收集的数据。受试者：1980年11月至1997年12月出生的1142名围产期获得性HIV感染儿童，平均随访时间为5.9年。主要结果测量HIV相关死亡的时间，计算出生队列和日历周期，并按主要抗逆转录病毒治疗类型的分布随时间进行分组。1997年出生队列（死亡的粗相对危险度[RH]，0.39; 95%置信区间[CI]，0.15-0.96）和1996-1998日历期死亡粗相对湿度0.65; 95% CI，0.45-0.95），比1980-1995年出生队列和日历期的数据高，但在调整妊娠期母体抗逆转录病毒治疗和分娩时的临床状况、胎龄和出生体重后，（出生队列校正的死亡相对湿度为0.55; 95% CI为0.20-1.50;日历期校正的死亡相对湿度为0.71，95% CI为0.43-1.16）。在一个以1980-1995年为比较的多变量模型中，1996-1997年出生队列的相对湿度为0.57（95%CI，0.22-1.47; P= 0.27），而1996-1998年的相对湿度为0.63（95%CI，0.47-0.85; P = 0.27）。
Context Since the introduction of combined antiretroviral therapy, mortality rates in adults with human immunodeficiency virus type 1 (HIV-1) infection have decreased. However, little information is available outside the setting of controlled trials on survival of perinatally HIV-infected children treated with antiretroviral therapy.Objective To assess effect of availability of antiretroviral therapy on decreasing mortality in perinatally HIV-infected children,Design Population-based, multicenter longitudinal study involving data collected by the Italian Register for HIV Infection in Children.Setting A network of 106 pediatric clinical centers.Subjects A total of 1142 children born between November 1980 and December 1997 with perinatally acquired HIV infection with a median follow-up of 5.9 years.Main Outcome Measure Time to HIV-related death calculated for birth cohort and calendar period and grouped by distribution of predominant type of antiretroviral therapy administered over time.Results Survival was longer in the 1996-1997 birth cohort (crude relative hazard [RH] of death, 0.39; 95% confidence interval [CI], 0.15-0.96) and 1996-1998 calendar period (crude RH of death, 0.65; 95% CI, 0.45-0.95) than in birth cohort and calendar period 1980-1995, but not when adjusted for maternal antiretroviral treatment during pregnancy and clinical condition at time of delivery, gestational age, and birth weight (adjusted RH of death, 0.55; 95% CI, 0.20-1.50, for birth cohort; and adjusted RH of death, 0.71, 95% CI, 0.43-1.16, for calendar period). in a multivariate model with 1980-1995 as comparison, the 1996-1997 birth cohort had an RH of 0.57 (95% CI, 0.22-1.47; P=.27) but RH for calendar period 1996-1998 was 0.63 (95% CI, 0.47-0.85; P