在早期开始抗逆转录病毒治疗后,在患有围产期获得的艾滋病毒的儿童中追踪肺功能
André Gie1, Claire Davies2, Florin Vaida3
1Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa agie@sun.ac.za.
Thorax
|July 21, 2023
概括
在患有周产期艾滋病毒感染 (CHIV) 的儿童中,早期抗逆转录病毒治疗 (ART) 能够保持肺功能,尽管小呼吸道疾病仍然是一个问题. 没有感染的周产期艾滋病毒暴露 (CHEU) 并没有影响肺功能轨迹.
科学领域:
- 儿科肺病学 儿科肺病学
- 传染病 传染病 传染病
- 公共卫生 公共卫生
背景情况:
- 肺部疾病是患有围产期艾滋病毒感染 (CHIV) 和没有感染的暴露 (CHEU) 的儿童的常见并发症,导致肺功能减弱.
- 虽然早期抗逆转录病毒疗法 (ART) 改善了CHIV的存活率和其他结果,但其对肺功能的具体益处尚不清楚.
研究的目的:
- 评估早期ART启动对HIV未暴露儿童 (CHU) 与HIV未暴露儿童 (CHU) 的肺功能轨迹的影响.
- 与CHU相比,评估无感染的周产期艾滋病毒暴露 (CHEU) 对儿童肺功能轨迹的影响.
主要方法:
- 未来的肺功能测试 (PFT) 包括螺旋计,囊造影和扩散能力在CHIV (ART开始在中位数为4.0个月),CHEU和CHU的队列中从2013年到2020年进行.
- 使用线性混合效应模型和多次归算来确定肺功能轨迹,将CHIV与CHU和CHEU与CHU进行比较,同时考虑潜在的混因素.
主要成果:
- 螺旋体检结果 (FEV1,FVC,FEV1/FVC) 在所有组中都相似.
- 与CHU相比,患有CHIV的儿童的平均残留体积 (RV) z-score显著增加 (17%的增加,p=0.042),表明潜在的小气道异常.
- 两组之间没有观察到肺总容量 (TLC) 或RV/TLCz分数的显著差异;艾滋病毒暴露组的气泡体积 (VA) 根据性别有所不同.
结论:
- 在CHIV中早期启动ART似乎可以减轻肺功能下降,在整个童年提供持久的好处,但对小呼吸道疾病的担忧仍然存在.
- 没有感染的周产期艾滋病毒暴露 (CHEU) 似乎不会扰乱儿童肺功能发育的正常轨迹.
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