广州市HIV感染儿童抗病毒治疗后CD4/CD8比值正常化影响因素分析:一项回顾性队列研究

CD4/CD8 ratio recovery of HIV-infected children receiving antiviral therapy in Guangzhou: A Retrospective Cohort Study

目的 探讨广州市经母婴传播的HIV感染儿童CD4/CD8比值的变化情况及影响因素。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年间经母婴传播、年龄<15岁、接受ART的HIV感染的儿童资料,采用Log-rank检验、Cox比例风险回归模型分析患儿CD4/CD8比值正常化的影响因素,并绘制K-M曲线。结果本研究纳入186例HIV感染儿童,CD4/CD8比值正常化88例,累积观察529.59人年,CD4/CD8比值正常化的总发生率为16.62/100人年。ART后1、2、5、10年CD4/CD8比值正常化率分别为17.74%、28.49%、43.01%、47.31%。多因素Cox比例风险回归分析显示CD4/CD8比值正常化与开始ART的年龄和基线CD4细胞计数有关。开始ART年龄≥2岁患儿CD4/CD8比值正常化的可能较<2岁患儿低(HR=0.281,95%CI:0.145~0.543);基线CD4细胞计数≥500个/μL患儿CD4/CD8比值正常化的可能是CD4细胞计数<500个/μL患儿的2.362倍(HR=2.362,95%CI:1.142~4.885)。结论HIV感染儿童接受长期ART后,CD4/CD8比值未恢复到正常化的人数仍然较多,尽早启动ART,早发现、早治疗是促进患儿CD4/CD8比值恢复的关键。

Objective To investigate the changes of CD4/CD8 ratio and the influencing factors in HIV-infected children via vertical transmission from their mothers in Guangzhou. Methods The data of HIV-infected children aged <15 years who were infected through mother-to-child transmission and received ART from 2004 to 2019 in the HIV infection treatment database of a designated infectious disease hospital in Guangzhou were collected. Log-rank test and Cox proportional hazards regression model were used to analyze the influencing factors of normalization of CD4/CD8ratio, and K-M curve was plotted. Results 186 HIV-infected children were included in this study, with 88 having normalization of CD4/CD8 ratio and 529.59 person-years of cumulative observation. The overall incidence of normalization of CD4/CD8 ratio was 16.62/100 person-years. The normalization rates of CD4/CD8 ratio at 1, 2, 5, and 10years after ART were 17.74%, 28.49%, 43.01%, and 47.31%, respectively. Multivariate Cox proportional hazards regression analysis showed that normalization of CD4/CD8 ratio was associated with age at ART initiation and baseline CD4 cell count. Children aged ≥ 2 years initiating ART were less likely to have normalized CD4/CD8 ratios than those aged < 2 years(HR = 0.281, 95% CI: 0.145 to 0.543). Children with baseline CD4 cell counts ≥ 500 cells/μL were 2.362-fold more likely to have normalized CD4/CD8 ratios than those with CD4 cell counts < 500 cells/μL(HR =2.362, 95% CI: 1.142 to 4.885). Conclusions The number of HIV-infected children receiving long-term ART who do not return to normalization of CD4/CD8ratio remained high. Early initiation of ART, early detection and early treatment are the key to promote the recovery of CD4/CD8 ratio in children.