摘要
目的探讨经母婴传播的HIV感染儿童接受ART后基线免疫抑制水平对患儿免疫状况的影响。方法收集广州市某传染病专科医院HIV感染者治疗库中2004-2019年经母婴传播、年龄<15岁接受ART的HIV感染儿童资料,将HIV感染儿童按年龄和基线CD4细胞水平分为无、轻中度、重度免疫抑制三组;构建广义估计方程(GEE)分析患儿基线免疫抑制水平对患儿长期免疫学疗效的影响。结果196例HIV感染儿童基线CD4细胞、CD8细胞计数和CD4/CD8比值的M(P_(25),P_(75))分别为267.0(41.0,664.0)个/μL、1094.5(635.0,1749.0)个/μL和0.19(0.04,0.42)。广义估计方程分析结果显示,调整开始ART年龄、性别、开始治疗年份等混杂因素后,基线免疫抑制水平、治疗时间及其交互作用对CD4细胞、CD8细胞和CD4/CD8比值的变化趋势有影响(P<0.001)。与基线相比,ART后重度免疫抑制组患儿CD4细胞和CD4/CD8比值在治疗第1年变化最快(RR值最大),但以较低水平进入平台期。无免疫抑制组患儿ART后CD4细胞、CD4/CD8比值在治疗第1年内增加,且平台期可维持在较高水平。所有患儿的CD8细胞在治疗1年后均缓慢降低。结论母婴传播的HIV感染儿童在基线无免疫抑制时接受ART能有效延缓免疫水平的降低,患儿的免疫状况可长期维持在较高水平,中重度免疫抑制组儿童ART 1年内免疫水平迅速上升,但在平台期仍低于无免疫抑制组。
Objective To investigate the effect of baseline immunosuppression level on the immune status of children living with HIV by mother-to-child transmission after receiving ART treatment in Guangzhou.Methods The data of mother-to-child transmission of HIV-infected children aged less than 15 who received ART from an infectious diseases hospital were collected in Guangzhou from 2004 to 2019.According to age and baseline CD4 level,196 cases were divided into non-immunosuppression,mild and moderate immunosuppression,and severe immunosuppression groups.Generalized Estimating Equation(GEE)was used to analyze the influence of baseline immunosuppression level on long-term immunological efficacy.Results The median and quartile of baseline CD4 cells,CD8 cells,and CD4/CD8 ratio were 267.0(41.0,664.0)cells perμL,1094.5(635.0,1749.0)cells perμL and 0.19(0.04,0.42),respectively.Generalized estimation equation analysis showed that after adjusting for confounding factors such as age,gender,and age of starting ART treatment,baseline CD4 level,treatment time,and their interaction was associated with the change trends of CD4 cells,CD8 cells,and CD4/CD8 ratio(P<0.001).Comparing with baseline,the changes of CD4 cells and CD4/CD8 ratio in the severe immunosuppression group were the largest in the first year of treatment(RR value is the largest),then entered the plateau phase in the lower immune level.In the non-immunosuppression group,the CD4 cells and CD4/CD8 ratio increased in the first year after ART,and maintained at a high level in the plateau stage;the CD8 cells decreased slowly after one year treatment in all groups.Conclusions Children living with HIV after ART in non-immunosuppression at baseline could delay the decrease of immune level effectively,and the immune status of children could be maintained at a high level for a long time.The resistance level of children in the moderate and severe immunosuppression groups increased rapidly within one year.However,it was still lower than that of the non-immunosuppressive group at the
作者
饶淑芳
李粤平
梁颖芳
江洪波
邓凯升
黄珍惠
徐华富
李章龙
邱园园
宋芯蕊
郜艳晖
贾卫东
李丽霞
RAO Shufang;LI Yueping;LIANG Yingfang;JIANG Hongbo;DENG Kaisheng;HUANG Zhenhui;XU Huafu;LI Zhanglong;QIU Yuanyuan;SONG Xinrui;GAO Yanhui;JIA Weidong;LI Lixia(School of Public Health,Guangdong Pharmaceutical University,Guangzhou 510310,China;Institute of Guangzhou Eighth People's Hospital Affiliated to Guangzhou Medical University,Guangzhou 510060;School of Basic Medical Sciences and Public Health,Jinan University,Guangzhou 510632)
出处
《中国艾滋病性病》
CAS
CSCD
北大核心
2021年第11期1207-1211,共5页
Chinese Journal of Aids & STD
基金
国家自然科学基金(81703282)。
关键词
艾滋病
抗病毒治疗
CD4细胞
CD8细胞
CD4/CD8比值
免疫学疗效
Acquired immune deficiency syndrome
Antiviral therapy
CD4+T lymphocyte count
CD8+T lymphocyte count
CD4/CD8 ratio
Immune efficacy
