Treatment‐Mediated Changes in Human Immunodeficiency Virus (HIV) Type 1 RNA and CD4 Cell Counts as Predictors of Weight Growth Failure, Cognitive Decline, and Survival in HIV‐Infected Children
作者:Jane C. Lindsey、Michael D. Hughes、Ross E. McKinney、Mary K. Cowles、Janet A. Englund、Carol J. Baker、Sandra K. Burchett、Mark W. Kline、Andrea Kovacs、Jack Moye
DOI:10.1086/315865
日期:2000.11
This meta-analysis of 5 large studies of the Pediatric AIDS Clinical Trials Group was undertaken to evaluate the predictive value of antiretroviral treatment-mediated changes in 3 markers of human immunodeficiency virus (HIV) type 1 disease progression—HIV-1 RNA level, CD4 cell count, and CD4 percentage—for weight growth failure, cognitive decline, and survival in HIV-infected children. Proportional hazards models were used to assess the prognostic value of the markers at baseline and after 24 weeks of treatment, with data from 1089 children. Among children receiving nucleoside with or without nonnucleoside reverse-transcriptase inhibitors, higher immunologic and lower virologic markers at baseline and after 24 weeks were significant independent predictors of survival, whereas virologic markers were significant predictors of weight growth and cognitive failure in children >1 year old. The finding of differential age effects on pediatric-specific clinical outcomes emphasizes the need for continued investigation of treatment effects in children.
本研究对儿科艾滋病临床试验组的 5 项大型研究进行了荟萃分析,以评估抗逆转录病毒治疗介导的人类免疫缺陷病毒(HIV)1 型疾病进展的 3 个指标--HIV-1 RNA 水平、CD4 细胞计数和 CD4 百分比的变化对 HIV 感染儿童体重增长失败、认知能力下降和存活率的预测价值。我们使用比例危险模型评估了这些指标在基线和治疗 24 周后的预后价值,数据来自 1089 名儿童。在接受核苷类与非核苷类逆转录酶抑制剂治疗的儿童中,基线和24周后较高的免疫学指标和较低的病毒学指标是生存率的重要独立预测因素,而病毒学指标则是体重增长和1岁以上儿童认知功能衰竭的重要预测因素。对儿童特异性临床结果的不同年龄影响的发现强调了继续研究儿童治疗效果的必要性。