广西2004——2019年初始抗病毒治疗儿童HIV感染者生长发育情况分析

Analysis of the growth and development of HIV-infected children on initiated ART in Guangxi, 2004-2019

目的 了解初始抗病毒治疗儿童HIV感染者的生长发育情况及其影响因素。方法 采用回顾性队列研究方法,从国家艾滋病抗病毒治疗信息系统下载广西2004—2019年初始抗病毒治疗儿童HIV感染者数据库。根据中国儿童生长发育标准计算Z评分,趋势性分析采用Cox-Stuart检验,广义估计方程用于分析HAZ(height-for-age Z-score)≥-2和WAZ(weight-for-age Z-score)≥-2的影响因素。结果 共计943例儿童HIV感染者进入队列。基线和治疗后第1、2、5、10年的HAZ中位数分别为-2.47、-2.14、-1.94、-1.55、-1.23,WAZ中位数分别为-1.85、-1.40、-1.30、-1.21、-1.09。经Cox-Stuart趋势检验,HAZ和WAZ随治疗时间均呈上升趋势(P<0.05)。基线和治疗后第1、2、5、10年HAZ≥-2的比例分别为38.1%、46.5%、51.6%、66.8%和74.6%,WAZ≥-2的比例分别为57.1%、76.9%、81.1%、85.8%和89.2%。经CoxStuart趋势检验,HAZ≥-2和WAZ≥-2的比例随治疗时间均呈上升趋势(P<0.05)。多因素广义估计方程分析结果显示,与HAZ≥-2的关联性因素有初始抗病毒治疗年龄为3~7岁(a OR=0.71,95%CI:0.53~0.94)、初始抗病毒治疗年龄为>7岁(a OR=0.66,95%CI:0.47~0.93)、治疗前CD4+T淋巴细胞计数<200个/μL(a OR=0.64,95%CI:0.47~0.87)、治疗前WHO临床分期为Ⅲ/Ⅳ期(a OR=0.74,95%CI:0.56~0.97)以及治疗时间(a OR=1.01,95%CI:1.01~1.01);与WAZ≥-2的关联性因素有男性(a OR=0.72,95%CI:0.53~0.97)、治疗前WHO临床分期为Ⅲ/Ⅳ期(a OR=0.63,95%CI:0.45~0.86)以及治疗时间(a OR=1.01,95%CI:1.01~1.01)。结论 抗病毒治疗有效改善了儿童HIV感染者的生长发育状况,但治疗后第10年仍有较大比例的儿童生长发育迟缓,需加强抗病毒治疗工作人员培训和儿童HIV感染者父母宣传教育以提高抗病毒治疗效果并合理指导儿童营养。

Objective To investigate the growth and development of HIV-infected children initiating antiretroviral therapy (ART) and its influencing factors.Methods This retrospective cohort study was conducted in Guangxi.HIV-infected children initiating free antiretroviral therapy (ART) from 2004 to 2019 were included.Z-score was calculated according to the Chinese Child Growth and Development Standard,the Cox-Stuart test was used for trend analysis,and the generalized estimating equation was used to analyze HAZ (Height-for-age Z-score)≥-2 and WAZ (Weight-for-age Z-score)≥-2 influencing factors.Results A total of 943 children with HIV infection were enrolled in the cohort.The median HAZ at baseline and 1,2,5,and 10 years after treatment was-2.47,-2.14,-1.94,-1.55,-1.23,respectively,and the median WAZ was-1.85,-1.40,-1.30,-1.21,-1.09,respectively.By Cox-Stuart trend test,HAZ and WAZ showed an upward trend with the treatment time (P<0.05).The proportions of HAZ≥-2 at baseline and at 1,2,5,and 10 years after treatment were 38.1%,46.5%,51.6%,66.8%,and 74.6%,respectively,and the proportions of WAZ≥-2 were 57.1%,76.9%,81.1%,85.8%and89.2%,respectively.According to Cox-Stuart trend test,the proportions of HAZ≥-2 and WAZ≥-2 increased with the treatment time (P<0.05).The results of multivariate generalized estimating equation analysis showed that the associated factors with HAZ≥-2 were that age at ART initiation was 3-7 years old (a OR=0.71,95%CI:0.53-0.94),age at ART initiation was>7 years old(a OR=0.66,95%CI:0.47-0.93),CD4 cell counts before ART was<200/μL (a OR=0.64,95%CI:0.47-0.87),WHO clinical stage before ART was StageⅢ/Ⅳ(aOR=0.74,95%CI:0.56-0.97) and time on ART (a OR=1.01,95%CI:1.01-1.01);the associated factors with WAZ≥-2 were male (a OR=0.72,95%CI:0.53-0.97),WHO clinical stage before ART was StageⅢ/Ⅳ(a OR=0.63,95%CI:0.45-0.86) and time on ART (a OR=1.01,95%CI:1.01-1.01).Conclusion Antiretroviral therapy can effectively improve the growth and development status of children with HIV infection,but a large proportion of children still have stunted growth and development in the 10th year after treatment.It is necessary to strengthen the training of antiretroviral treatment staff and the publicity and education of parents of children infected with HIV.Improve the effect of antiviral treatment and guide children’s nutrition reasonably.