Changing patterns of clinical events in perinatally HIV-1-infected children during the era of HAART
Changing patterns of clinical events in perinatally HIV-1-infected children during the era of HAART
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DOI：
10.1097/qad.0b013e32823ecf5b
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发表时间：
2007-07-31
期刊：
影响因子：
3.8
通讯作者：
de Martino, Maurizio
中科院分区：
文献类型：
--
作者：
Chiappini, Elena;Galli, Luisa;de Martino, Maurizio
背景：HAART的引入降低了围产期hiv -1感染儿童的死亡率和艾滋病进展，但关于特定临床事件发生率的改变信息有限。方法：对在意大利儿童艾滋病毒感染登记册登记的1402名围产期感染艾滋病毒的儿童进行了一项观察性人群研究，研究HIV-1相关发病率的变化，并在haart前（1985-1995年）和haart后（1996-2000年和2001 -2005年）进行前瞻性随访。在这一组中，773名儿童（55.1%）从出生起就被跟踪。中位观察时间为8.58年（四分位数差为3.71 ~ 13.72）。结果：总体而言，666名（47.5%）儿童发生艾滋病，420名（29.9%）死亡。Kaplan-Meier分析表明，随着时间的推移，生存率有所提高（P < 0.0001）。泊松回归分析表明，1996-2000年，美国疾病控制与预防中心B类和C类临床事件发生率以及大多数hiv -1相关器官并发症发生率显著下降。2000年以后，癌症和机会性感染的发病率显著下降。然而，在2001-2005年期间，机会性感染的发生率仍然很高（6.09/100人年），细菌感染率很高（3.55/100人年），特别是肺炎（1.66/100人年）。58.5%的肺炎患儿CD4细胞百分比为0.15%。结论：在HAART时代，死亡率和B类和C类临床事件（包括器官并发症）的发生率逐渐降低。然而，严重的细菌感染，特别是肺炎，即使在没有严重的CD4细胞耗竭的情况下，仍然以相当高的比率发生。(c) 2007年Lippincott Williams & Wilkins。
Background: The introduction of HAART has decreased mortality and progression to AIDS in perinatally HIV-1-infected children, but information on modification of the rate of specific clinical events is limited.Method: An observational population study on changes in HIV-1-related morbidity was conducted on 1402 perinatally HIV-1-infected children enrolled in the Italian Register for HIV Infection in Children and prospectively followed in the pre-HAART (1985-1995) and post-HAART periods (1996-2000, and 2001 -2005). Of this group, 773 children (55.1%) were followed from birth. Median observation time was 8.58 years (interquartile range, 3.71-13.72).Results: Overall, 666 (47.5%) children developed AIDS and 420 (29.9%) died. improved survival over time was evidenced at Kaplan-Meier analysis (P < 0.0001). Poisson regression analysis indicated that Centers for Disease Control and Prevention class B and C clinical event rates and most of the HIV-1-related organ complication rates significantly decreased starting from 1996-2000. Significant reductions in rates of cancer and opportunistic infections were evidenced after 2000. Nevertheless, opportunistic infections still occurred at high rates (6.09/100 person-years) in 2001-2005, with high rate of bacterial infections (3.55/100 person-years), particularly pneumonia (1.66/100 person-years), in this period. CD4 cell percentage was > 15% in 58.5% children with pneumonia.Conclusions: Progressive reductions of both mortality and rates of class B and C clinical events, including organ complications, were evidenced in the HAART era. Nevertheless, severe bacterial infections, particularly pneumonia, still occurred at considerable high rates, even in the absence of a severe CD4 cell depletion. (c) 2007 Lippincott Williams & Wilkins.