Survival in children with perinatally acquired human immunodeficiency virus type 1 infection.
Survival in children with perinatally acquired human immunodeficiency virus type 1 infection.
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围产期获得性人类免疫缺陷病毒 1 型感染儿童的存活率。
DOI：
10.1056/nejm198912283212604
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发表时间：
1989
期刊：
影响因子：
--
通讯作者：
Parks,WP
中科院分区：
文献类型：
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作者：
Scott,GB;Hutto,C;Makuch,RW;Mastrucci,MT;O'Connor,T;Mitchell,CD;Trapido,EJ;Parks,WP
我们描述了佛罗里达州迈阿密杰克逊纪念医院的经验，该医院有 172 名儿童被诊断为围产期获得性人类免疫缺陷病毒 1 型 (HIV-1) 感染。 146 名儿童母亲通过异性接触 (69%)、静脉注射毒品 (30%) 或输血 (1%) 感染 HIV-1。这些儿童在中位年龄 8 个月时出现症状；只有 21% 是在两岁之后出现的。最常见的疾病首发表现是淋巴样间质性肺炎（17%）、脑病（12%）、反复细菌感染（10%）和念珠菌食管炎（8%），其诊断后的中位生存时间分别为 72、11、50 和 12 个月。 9% 的儿童在中位年龄 5 个月时患有卡氏肺孢子虫肺炎，中位生存期仅为 1 个月。所有 172 名儿童的中位生存期从诊断之日算起为 38 个月。生命第一年的死亡率最高（17%），根据比例风险分析，长期生存的概率很低。在多变量分析中，发现诊断时的早期年龄和首次可识别的临床疾病模式与生存独立相关。我们的结论是，围产期获得 HIV-1 感染的儿童预后非常差，大多数在一岁之前出现症状。早期诊断很重要，因为在疾病进展之前启动预防性或抗病毒治疗的时间很短。 （新英格兰医学杂志 1989；321：1791–6。）
We describe our experience at Jackson Memorial Hospital in Miami, Florida, with 172 children who were given diagnoses of perinatally acquired infection with human immunodeficiency virus type 1 (HIV-1). The 146 mothers of the children acquired HIV-1 through heterosexual contact (69 percent), intravenous drug use (30 percent), or blood transfusion (1 percent).The children presented with symptomatic disease at a median age of eight months; only 21 percent presented after the age of two years. The most common first manifestations of disease were lymphoid interstitial pneumonia (in 17 percent), encephalopathy (in 12 percent), recurrent bacterial infections (in 10 percent), and candida esophagitis (in 8 percent), for which the median survival times from diagnosis were 72, 11, 50, and 12 months, respectively. Nine percent of the children hadPneumocystis cariniipneumonia at a median age of five months and had a median survival of only one month.The median survival for all 172 children was 38 months from the time of diagnosis. Mortality was highest in the first year of life (17 percent), and by proportional-hazard analysis the probability of long-term survival is low. In multi-variate analyses, early age at diagnosis and the first identifiable pattern of clinical disease were found to be independently related to survival.We conclude that children with perinatally acquired HIV-1 infection have a very poor prognosis and that most become symptomatic before one year of age. Early diagnosis is important, since there is only a short interval in which to initiate prophylactic or antiviral treatment before progressive disease begins. (N Engl J Med 1989; 321: 1791–6.)