Risks and predictors of mortality among human immunodeficiency virus-infected children receiving highly active antiretroviral therapy in Yunnan Province

中华传染病杂志 Pub Date : 2019-01-15 DOI:10.3760/CMA.J.ISSN.1000-6680.2019.01.005

Bihui Yang, Mi Zhang, Y. Shu, Jia-fa Liu, Jian-jian Li, Cuixian Yang, Jincheng Lou

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Abstract

Objective To investigate the influence factors of mortality among human immunodeficiency virus (HIV)-infected children under highly active antiretroviral therapy (HAART). Methods Retrospective cohort study of 652 children initiated HAART from 2005 to 2014 was conducted, and enrolled patients were followed-up until December, 2015. Survival data was analyzed using Kaplan-Meier method and Cox regression model was used to identify independent predictors of mortality among these children on HARRT. Chi-square test and Fisher′s exact test were used for comparison between groups. Results Overall, 26 of the children died over a follow-up period of 3 116.24 child-years, with a mortality rate of 0.83 per 100 child-years. Twelve (46%) of deaths occurred during the first six months after starting HAART. Cox regression analysis of variables showed that the World Health Organization (WHO) clinical stages Ⅲ/Ⅳ (hazard rate [HR]=10.717, 95% confidence interal [95% CI]: 4.189-4.749, P=0.000), baseline hemoglobin <80 g/L (HR=14.768, 95% CI: 5.721-38.125, P=0.000), tuberculosis co-infection (HR=4.794, 95%CI: 2.105-10.918, P=0.000), baseline CD4+ T lymphocyte<50 cells/μL (HR=4.219, 95%CI: 1.524-11.680, P=0.006), weight-for-age z-score <-2 (HR=2.983, 95%CI: 1.094-8.135, P=0.033)were independently associated with death, whereas the age <7 year-old at HAART initiation was protectire (HR=0.293, 95% CI: 0.126-0.684, P=0.005). Conclusions The mortality of children receiving HAART is strongly associated with WHO stages Ⅲ/Ⅳ, hemoglobin <80 g/L, weight-for-age z-score <-2, tuberculosis co-infection and older age at treatment. Key words: Child; Acquired immunodeficiency syndrome; Antiretroviral treatment

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云南省接受高效抗逆转录病毒治疗的人类免疫缺陷病毒感染儿童死亡率的风险和预测因素

目的探讨高效抗逆转录病毒治疗(HAART)对人类免疫缺陷病毒(HIV)感染儿童死亡率的影响因素。方法对2005 - 2014年接受HAART治疗的652例儿童进行回顾性队列研究，随访至2015年12月。生存率数据采用Kaplan-Meier法进行分析，Cox回归模型用于确定hart治疗患儿死亡率的独立预测因素。组间比较采用卡方检验和Fisher精确检验。结果随访3 116.24儿童年，死亡26例，死亡率0.83 / 100儿童年。12例(46%)死亡发生在开始HAART治疗后的头6个月内。各变量Cox回归分析显示，世界卫生组织(WHO)临床分期Ⅲ/Ⅳ(危险率[HR]=10.717, 95%可信区间[95% CI]: 4.189 ~ 4.749, P=0.000)、基线血红蛋白<80 g/L (HR=14.768, 95%CI: 5.721 ~ 38.125, P=0.000)、结核病合并感染(HR=4.794, 95%CI: 2.105 ~ 10.918, P=0.000)、基线CD4+ T淋巴细胞<50个/μL (HR=4.219, 95%CI: 1.524 ~ 11.680, P=0.006)、年龄体重比值z-score <-2 (HR=2.983, 95%CI:(1.094-8.135, P=0.033)与死亡独立相关，而在HAART开始时年龄<7岁具有保护作用(HR=0.293, 95% CI: 0.126-0.684, P=0.005)。结论接受HAART治疗的儿童死亡率与WHO分期Ⅲ/Ⅳ、血红蛋白<80 g/L、体重/年龄比值z-score <-2、结核病合并感染和治疗时年龄较大密切相关。关键词:儿童;获得性免疫缺陷综合征;抗逆转录病毒治疗

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来源期刊

中华传染病杂志

自引率

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发文量

5280

期刊介绍： The Chinese Journal of Infectious Diseases was founded in February 1983. It is an academic journal on infectious diseases supervised by the China Association for Science and Technology, sponsored by the Chinese Medical Association, and hosted by the Shanghai Medical Association. The journal targets infectious disease physicians as its main readers, taking into account physicians of other interdisciplinary disciplines, and timely reports on leading scientific research results and clinical diagnosis and treatment experience in the field of infectious diseases, as well as basic theoretical research that has a guiding role in the clinical practice of infectious diseases and is closely integrated with the actual clinical practice of infectious diseases. Columns include reviews (including editor-in-chief reviews), expert lectures, consensus and guidelines (including interpretations), monographs, short monographs, academic debates, epidemic news, international dynamics, case reports, reviews, lectures, meeting minutes, etc.