在Kembata-Tembaro地区开始抗逆转录病毒治疗后感染人类免疫缺陷病毒的儿童存活的决定因素：一项基于设施的回顾性队列研究

Global pediatrics Pub Date : 2025-04-17 DOI:10.1016/j.gpeds.2025.100257

Tarekegn Tessema , Mitiku Desalegn , Lonsako Abute , Tadele Yohannes

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引用次数: 0

摘要

艾滋病毒感染是医护人员面临的全球卫生最重大挑战之一。另一方面，营养不良在发展中国家很普遍；即使提供抗逆转录病毒治疗，在艾滋病毒阳性儿童中，这仍然是一个严重的问题。目的探讨2022年埃塞俄比亚南部肯巴塔-坦巴罗地区人类免疫缺陷病毒感染儿童开始抗逆转录病毒治疗后存活的决定因素。方法对2022年5月5日至6月4日在肯巴塔-坦巴罗地区公立医院接受抗逆转录病毒治疗的305名艾滋病毒感染儿童进行回顾性队列研究。使用清单收集数据。使用Epi info 3.5.3进行数据录入和清理，使用SPSS 25.0软件进行数据分析。采用Kaplan-Meier生存曲线计算抗逆转录病毒治疗开始后的累积生存时间。拟合多变量Cox比例模型以确定影响ART开始后生存的因素，P值≤0.05的变量被认为是死亡率的有统计学意义的预测因子。结果死亡43例（14.1%），总生存率为3.3 / 1000儿童月。营养不良儿童的生存时间低于营养良好儿童，平均生存时间分别为92.7个月和62.3个月。世卫组织临床III期或IV期晚期儿童(AHR: 6.1；95% CI: 1.4, 26.7)，基线时严重消瘦(AHR: 8.7；95% CI: 3.2, 23.6)，高病毒载量水平(AHR: 3.5；95% CI: 0.15, 0.61)和ART依从性一般/较差(AHR: 3.7；95% CI: 2.3, 13.5)与本研究中hiv阳性儿童的生存率显著相关。结论营养不良儿童与营养良好儿童生存时间差异显著，死亡率高。严重消瘦、WHO临床III期或IV期、高病毒载量水平和一般/较差的依从性被确定为生存的决定因素。

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Determinants of survival of human immune deficiency virus infected children after commencing anti-retroviral therapy in Kembata-Tembaro zone: A facility-based retrospective cohort study

Background

HIV infection is one of the most significant challenges to global health faced by care providers. On the other hand, malnutrition is prevalent in developing countries; it remains a serious problem among HIV-positive children even with the provision of Anti-Retroviral Therapy (ART).

Objective

To explore determinants of survival of human immune deficiency virus-infected children after commencing Anti-Retroviral Therapy in Kembata-Tembaro Zone, Southern Ethiopia, 2022.

Methods

A facility-based retrospective cohort study was employed among 305 HIV-infected children on ART from May 5-June 4/2022 at public hospitals in Kembata-tembaro zone. The data were collected by using a checklist. Data were entered and cleaned using Epi info 3.5.3 and analysed using SPSS version 25.0 software. The cumulative survival time after initiation of ART was calculated using the Kaplan-Meier survival curve. A Multivariable Cox proportional model was fitted to identify factors affecting survival after initiation of ART and variables having P value≤ 0.05 were considered statistically significant predictors of mortality.

Results

Overall, 43(14.1 %) died with an overall survival rate of 3.3 per 1000 child-months of observation. Undernourished children had a lower survival time than well-nourished children with mean survival time of 92.7 and 62.3 months respectively. Children with advanced WHO clinical stage III or IV (AHR: 6.1; 95 %CI: 1.4, 26.7), severe wasting at the baseline (AHR: 8.7; 95 %CI: 3.2, 23.6), high viral load level (AHR: 3.5; 95 %CI: 0.15, 0.61) and fair/poor adherence to ART (AHR: 3.7; 95 %CI: 2.3, 13.5) were significantly associated with survival of HIV-positive children in this study.

Conclusion

a significant difference in survival time was observed between undernourished and well-nourished children with a high rate of mortality. Severe wasting, WHO clinical stage III or IV, high viral load level and fair/poor adherence were identified as the determinants of survival.

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Global pediatrics Perinatology, Pediatrics and Child Health

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