摘要
Context:Combination antiretroviral therapy or highly active antiretroviral therapy (HAART) has resulted in a dramatic decline in the incidence of opportunistic and other infections in human immunodeficiency virus (HIV)-infected adults and children. Objectives:To estimate the incidence of 29 targeted opportunistic and other infections occurring in the era of HAART -between January 1,2001,and December 31,2004 -in HIV-infected infants,children,and adolescents followed up in Pediatric AIDS Clinical Trials Group (PACTG) 219C; to compare incidence rates in the HAART era to those of the pre-HAART era; and to test for linear trends over time in the HAART era. Design,Setting,and Participants:Ongoing,multicenter,prospective cohort study designed to examine long-term outcomes in HIV-infected children. The study population included 2767 children enrolled between September 15,2000,and December 31,2004,with information entered in the database up to August 1,2005,when data analysis was conducted. The pre-HAART era comparison population included 3331 children enrolled in 13 PACTG protocols from October 1988 to August 1998.Main Outcome Measures:First occurrence of each of the 29 targeted infections. Results:Seventy-five percent of the children were enrolled in 2000 and 2001,90%acquired HIV perinatally,52%were girls,and 59%were black. The median age was 8.2 years (range,6-13 years). The median duration of follow-up was 3.4 years.Overall,553 first episodes of a specific infection occurred among 395 (14%) of the study participants. The number of events for the 4 most common first-time infections and their incidence rates (IRs) per 100 person-years were 123 bacterial pneumonia (IR,2.15; 95%confidence interval CI ,1.79-2.56),77 herpes zoster (IR,1.11; 95%CI,0.88-1.39),57 dermatophyte infections (IR,0.88; 0.67-1.14),and 52 oral candidiasis (IR,0.93; 95%CI,0.70-1.22). Incidencerates of first bacteremia,Pneumocystis jeroveci pneumonia,disseminated Mycobacterium avium complex,lymphoid interstitial pneumonitis,systemic fungal infection,cytomegalovirus retinitis,and tuberculosis were all less than 0.50 per 100 person-years. There were no statistically significant linear trends in incidence for any of the 29 infections over the 4 calendar years. However,infection rates were significantly lower than those reported in the PACTG in the pre-HAART era. The pre-HAART IRs were as follows:for bacterial pneumonia,IR,11.1; 95%CI,10.3-12.0; bacteremia,IR,3.3; 95%CI,2.9-3.8; herpes zoster,IR,2.9; 95%CI,2.6-3.3; disseminated M avium complex,IR,1.8; 95%CI,1.5-2.1; P jeroveci,IR,1.3; 95%CI,1.1-1.6; oral candidiasis,IR,1.2;95%CI,1.0-1.5; cytomegalovirus retinitis,IR,0.5; 95%CI,0.3-0.6; and tuberculosis,IR,0.2; 95%CI,0.1-0.4.Conclusions:Opportunistic infections and other related infections are uncommon in children in the HAART era,and infection rates continue to be lower than those reported in the pre-HAART era. Continued surveillance is important to assess the long-term effect of HAART on the occurrence of opportunistic and other related in fections in children.
Context:Combination antiretroviral therapy or highly active antiretroviral therapy (HAART) has resulted in a dramatic decline in the incidence of opportunistic and other infections in human immunodeficiency virus (HIV)-infected adults and children. Objectives:To estimate the incidence of 29 targeted opportunistic and other infections occurring in the era of HAART -between January 1,2001,and December 31,2004 -in HIV-infected infants,children,and adolescents followed up in Pediatric AIDS Clinical Trials Group (PACTG) 219C; to compare incidence rates in the HAART era to those of the pre-HAART era; and to test for linear trends over time in the HAART era. Design,Setting,and Participants:Ongoing,multicenter,prospective cohort study designed to examine long-term outcomes in HIV-infected children. The study population included 2767 children enrolled between September 15,2000,and December 31,2004,with information entered in the database up to August 1,2005,when data analysis was conducted. The pre-HAART era comparison population included 3331 children enrolled in 13 PACTG protocols from October 1988 to August 1998.Main Outcome Measures:First occurrence of each of the 29 targeted infections. Results:Seventy-five percent of the children were enrolled in 2000 and 2001,90%acquired HIV perinatally,52%were girls,and 59%were black. The median age was 8.2 years (range,6-13 years). The median duration of follow-up was 3.4 years.Overall,553 first episodes of a specific infection occurred among 395 (14%) of the study participants. The number of events for the 4 most common first-time infections and their incidence rates (IRs) per 100 person-years were 123 bacterial pneumonia (IR,2.15; 95%confidence interval CI ,1.79-2.56),77 herpes zoster (IR,1.11; 95%CI,0.88-1.39),57 dermatophyte infections (IR,0.88; 0.67-1.14),and 52 oral candidiasis (IR,0.93; 95%CI,0.70-1.22). Incidencerates of first bacteremia,Pneumocystis jeroveci pneumonia,disseminated Mycobacterium avium complex,lymphoid interstitial pneumonitis,systemic fungal infection,cytomegalovirus retinitis,and tuberculosis were all less than 0.50 per 100 person-years. There were no statistically significant linear trends in incidence for any of the 29 infections over the 4 calendar years. However,infection rates were significantly lower than those reported in the PACTG in the pre-HAART era. The pre-HAART IRs were as follows:for bacterial pneumonia,IR,11.1; 95%CI,10.3-12.0; bacteremia,IR,3.3; 95%CI,2.9-3.8; herpes zoster,IR,2.9; 95%CI,2.6-3.3; disseminated M avium complex,IR,1.8; 95%CI,1.5-2.1; P jeroveci,IR,1.3; 95%CI,1.1-1.6; oral candidiasis,IR,1.2;95%CI,1.0-1.5; cytomegalovirus retinitis,IR,0.5; 95%CI,0.3-0.6; and tuberculosis,IR,0.2; 95%CI,0.1-0.4.Conclusions:Opportunistic infections and other related infections are uncommon in children in the HAART era,and infection rates continue to be lower than those reported in the pre-HAART era. Continued surveillance is important to assess the long-term effect of HAART on the occurrence of opportunistic and other related in fections in children.
