Survival of HIV-Infected Children: A Cohort Study From the Asia-Pacific Region
Survival of HIV-Infected Children: A Cohort Study From the Asia-Pacific Region
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DOI：
10.1097/qai.0b013e318207a55b
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发表时间：
2011-04-01
影响因子：
3.6
通讯作者：
Sohn, Annette H.
中科院分区：
文献类型：
--
作者：
Lumbiganon, Pagakrong;Kariminia, Azar;Sohn, Annette H.
背景：自2002年以来，联合抗逆转录病毒疗法（ART）已在许多亚洲国家用于艾滋病毒感染儿童。本研究描述了艾滋病病毒感染的儿童在一个多中心的区域队列在Asia.Patients和方法：回顾性和前瞻性的数据收集到2009年3月从5个国家的儿童在治疗亚洲的儿科艾滋病病毒观察数据库进行了分析。多变量考克斯比例风险模型用于评估与接受ART儿童死亡率相关的因素。结果：在2280名儿童中，1752名（77%）接受了ART。（6.6%）例死亡，粗死亡率为1.9/100儿童年[95%置信区间（CI）：1.6 - 2.4]。ART前3个月的死亡率最高（10.2/100儿童年; 95% CI：7.5 - 13.7），12个月后下降（0.9/100儿童年; 95% CI：0.7 - 1.3）。那些近期CD 4百分比较低，开始ART时基线年龄别体重Z评分较低，或WHO临床分期4的患者死亡风险增加。在528名（23%）从未接受过抗逆转录病毒治疗的儿童中，（6.8%）在接受护理后死亡，粗死亡率为每100儿童年4.1人（95% CI：3.0至5.7），每100儿童年的计划损失率为31.5结论：ART治疗前3个月的高死亡率和低CD 4细胞百分比的患者支持早期诊断和ART治疗的实施。
Background: Combination antiretroviral therapy (ART) has been used for HIV-infected children in many Asian countries since 2002. This study describes survival outcomes among HIV-infected children in a multicenter regional cohort in Asia.Patients and Methods: Retrospective and prospective data collected through March 2009 from children in 5 countries enrolled in TREAT Asia's Pediatric HIV Observational Database were analysed. Multivariate Cox proportional hazard models were used to assess factors associated with mortality in children who received ART.Results: Among 2280 children, 1752 (77%) had received ART. During a median follow-up of 3.1 years after ART, 115 (6.6%) deaths occurred, giving a crude mortality rate of 1.9 per 100 child-years [95% confidence interval (CI): 1.6 to 2.4]. The mortality rate was highest in the first 3 months of ART (10.2 per 100 child-years; 95% CI: 7.5 to 13.7) and declined after 12 months (0.9 per 100 child-years; 95% CI: 0.7 to 1.3). Those with a low recent CD4 percentage, who started ART with lower baseline weight-for-age Z score, or with WHO clinical stage 4 had an increased risk of death. Of 528 (23%) children who never received ART, 36 (6.8%) died after presenting to care, giving a crude mortality rate of 4.1 per 100 child-years (95% CI: 3.0 to 5.7), with a lost-to-program rate of 31.5 per 100 child-years (95% CI: 28.0 to 35.5).Conclusions: The high mortality during the first 3 months of ART and in those with low CD4 percentage support the implementation of early diagnosis and ART initiation.