Growth, immune and viral responses in HIV infected African children receiving highly active antiretroviral therapy: a prospective cohort study
Growth, immune and viral responses in HIV infected African children receiving highly active antiretroviral therapy: a prospective cohort study
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DOI：
10.1186/1471-2431-10-56
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发表时间：
2010-08-06
期刊：
影响因子：
2.4
通讯作者：
Fowler, Mary G.
中科院分区：
文献类型：
--
作者：
Musoke, Philippa M.;Mudiope, Peter;Fowler, Mary G.
背景资料：尽管常规实验室监测有限，但在资源有限的情况下继续扩大儿科抗逆转录病毒疗法。我们记录的体重和身高的反应，在艾滋病毒感染的乌干达儿童的高效抗逆转录病毒治疗和确定的临床因素与成功的治疗outcomes.Methods：一个前瞻性队列的艾滋病毒感染的儿童开始HAART，并随后为48周。计算年龄体重指数z评分（BAZ）、年龄体重和身高z评分（WAZ和HAZ）：在基线和每12周测量CD 4细胞%和HIV-1 RNA。治疗结果根据病毒学和免疫学成功（VS/IS）、病毒学失败和免疫学成功（VF/IS）进行分类。结果：从2004年3月至2006年5月，124例HIV感染儿童开始接受HAART治疗。中位年龄（IQR）为5.0岁（2.1 - 7.0），49%（61/124）为女性。基线时BAZ、WAZ和HAZ的中位数[95%置信区间（CI）]分别为0.29（-2.9，-1.2）、-1.2（-2.1，-0.5）和-2.06（-2.9，-1.2）。基线中位CD 4细胞%和log 10 HIV-1 RNA分别为：11.8%（7.5-18.0）和5.6（5.2-5.8）拷贝/ml。到48周时，VF/IS组（较年轻）的平均WAZ和HAZ分别从-0.98（SD 1.7）增加到+ 1.22（SD 1.2）和从-1.99（1.7）增加到+ 0.76（2.4）。VS/IF组（老年组）WAZ和HAZ的平均增加适度，分别为-1.84（1.3）至-0.41（1.2）和-2.25（1.2）至-1.16（1.3）。基线CD 4细胞% [OR 6.97 95% CI（2.6 - 18.6）]，年龄[OR 4.6 95% CI（1.14 - 19.1）]和WHO临床分期[ OR 3.5 95% CI（1.05 - 12.7）]与成功的治疗结果相关。艾滋病毒感染的乌干达儿童在HAART的前48周内表现出身高和体重z评分的强劲增长，包括那些未能完全抑制病毒的儿童。年龄较大的儿童开始HAART与严重的免疫抑制不太可能实现成功的治疗结果。这些数据强调了早期启动HAART的重要性，以确保足够的免疫和生长反应。
Background: Scale up of paediatric antiretroviral therapy in resource limited settings continues despite limited access to routine laboratory monitoring. We documented the weight and height responses in HIV infected Ugandan children on highly active antiretroviral therapy and determined clinical factors associated with successful treatment outcomes.Methods: A prospective cohort of HIV infected children were initiated on HAART and followed for 48 weeks. Body mass index for age z scores(BAZ), weight and height-for-age z scores (WAZ & HAZ) were calculated: CD4 cell % and HIV-1 RNA were measured at baseline and every 12 weeks. Treatment outcomes were classified according to; both virological and immunological success (VS/IS), virological failure and immunological success (VF/IS). virological success and immunological failure (VS/IF) and both virological and immunological failure (VF/IF).Results: From March 2004 until May 2006, 124 HIV infected children were initiated on HAART. The median age (IQR) was 5.0 years (2.1 - 7.0) and 49% (61/124) were female. The median [95% confidence interval (CI)] BAZ, WAZ and HAZ at baseline were 0.29 (-2.9, -1.2), -1.2 (-2.1, -0.5) and -2.06 (-2.9, -1.2) respectively. Baseline median CD4 cell % and log10 HIV-1 RNA were; 11.8% (7.5-18.0) and 5.6 (5.2-5.8) copies/ml. By 48 weeks, mean WAZ and HAZ in the VF/IS group, which was younger, increased from -0.98 (SD 1.7) to + 1.22 (SD 1.2) and from -1.99 (1.7) to + 0.76 (2.4) respectively. Mean increase in WAZ and HAZ in the VS/IF group, an older group was modest, from -1.84 (1.3) to -0.41 (1.2) and -2.25 (1.2) to -1.16 (1.3) respectively. Baseline CD4 cell % [OR 6.97 95% CI (2.6 - 18.6)], age [OR 4.6 95% CI (1.14 - 19.1)] and WHO clinical stage [ OR 3.5 95% CI (1.05 - 12.7)] were associated with successful treatment outcome.Conclusions: HIV infected Ugandan children demonstrated a robust increase in height and weight z scores during the first 48 weeks of HAART, including those who failed to completely suppress virus. Older children initiating HAART with severe immune suppression were less likely to achieve a successful treatment outcome. These data emphasize the importance of initiating HAART early to ensure adequate immune and growth responses.