PDF(Pubmed)
Abstract：
Seizures are relatively common among children with HIV in low- and middle-income countries and are associated with significant morbidity and mortality. Early treatment with antiretroviral therapy (ART) may reduce this risk by decreasing rates of central nervous system infections and HIV encephalopathy.
We conducted a prospective, unmatched case-control study. We enrolled children with new-onset seizure from University Teaching Hospital in Lusaka, Zambia and 2 regional hospitals in rural Zambia. Controls were children with HIV and no history of seizures. Recruitment took place from 2016 to 2019. Early treatment was defined as initiation of ART before 12 months of age, at a CD4 percentage >15% in children aged 12-60 months or a CD4 count >350 cells/mm 3 for children aged 60 months or older. Logistic regression models were used to evaluate the association between potential risk factors and seizures.
We identified 73 children with new-onset seizure and compared them with 254 control children with HIV but no seizures. Early treatment with ART was associated with a significant reduction in the odds of seizures [odds ratio (OR) 0.04, 95% confidence interval: 0.02 to 0.09; P < 0.001]. Having an undetectable viral load at the time of enrollment was strongly protective against seizures (OR 0.03, P < 0.001), whereas history of World Health Organization Stage 4 disease (OR 2.2, P = 0.05) or CD4 count <200 cells/mm 3 (OR 3.6, P < 0.001) increased risk of seizures.
Early initiation of ART and successful viral suppression would likely reduce much of the excess seizure burden in children with HIV.
We conducted a prospective, unmatched case-control study. We enrolled children with new-onset seizure from University Teaching Hospital in Lusaka, Zambia and 2 regional hospitals in rural Zambia. Controls were children with HIV and no history of seizures. Recruitment took place from 2016 to 2019. Early treatment was defined as initiation of ART before 12 months of age, at a CD4 percentage >15% in children aged 12-60 months or a CD4 count >350 cells/mm 3 for children aged 60 months or older. Logistic regression models were used to evaluate the association between potential risk factors and seizures.
We identified 73 children with new-onset seizure and compared them with 254 control children with HIV but no seizures. Early treatment with ART was associated with a significant reduction in the odds of seizures [odds ratio (OR) 0.04, 95% confidence interval: 0.02 to 0.09; P < 0.001]. Having an undetectable viral load at the time of enrollment was strongly protective against seizures (OR 0.03, P < 0.001), whereas history of World Health Organization Stage 4 disease (OR 2.2, P = 0.05) or CD4 count <200 cells/mm 3 (OR 3.6, P < 0.001) increased risk of seizures.
Early initiation of ART and successful viral suppression would likely reduce much of the excess seizure burden in children with HIV.
摘要：
背景：在低收入和中等收入国家，癫痫发作在感染艾滋病毒的儿童中相对普遍，并与显著的发病率和死亡率相关。抗逆转录病毒疗法的早期治疗可以通过降低中枢神经系统感染和HIV脑病的发生率来降低这种风险。
方法：我们进行了前瞻性，无与伦比的病例对照研究。我们从卢萨卡大学教学医院招募了新发作癫痫的儿童，赞比亚以及赞比亚农村的两家地区医院。对照组为患有HIV且无癫痫发作史的儿童。招聘时间为2016-2019年。早期治疗被定义为在12个月大之前开始ART。在12个月至60个月的儿童中，CD4百分比大于15％，或60个月或更大的儿童的CD4计数大于350细胞/mm3。采用Logistic回归模型评价潜在危险因素与癫痫发作的关系。
结果：我们确定了73名新发癫痫患儿，并将其与254名感染HIV但没有癫痫的对照儿童进行了比较。抗逆转录病毒治疗的早期治疗与癫痫发作几率显着降低相关（OR0.04，95％CI0.02-0.09；p<0.001）。在登记时检测不到病毒载量对癫痫发作具有强烈的保护作用（OR0.03，p<0.001），而WHO第4期疾病史（OR2.2，p=0.05）或CD4计数<200（OR3.6，p<0.001）增加了癫痫发作的风险。
结论：早期开始抗逆转录病毒治疗和成功的病毒抑制可能会在很大程度上减轻HIV患儿的过多癫痫发作负担。
方法：我们进行了前瞻性，无与伦比的病例对照研究。我们从卢萨卡大学教学医院招募了新发作癫痫的儿童，赞比亚以及赞比亚农村的两家地区医院。对照组为患有HIV且无癫痫发作史的儿童。招聘时间为2016-2019年。早期治疗被定义为在12个月大之前开始ART。在12个月至60个月的儿童中，CD4百分比大于15％，或60个月或更大的儿童的CD4计数大于350细胞/mm3。采用Logistic回归模型评价潜在危险因素与癫痫发作的关系。
结果：我们确定了73名新发癫痫患儿，并将其与254名感染HIV但没有癫痫的对照儿童进行了比较。抗逆转录病毒治疗的早期治疗与癫痫发作几率显着降低相关（OR0.04，95％CI0.02-0.09；p<0.001）。在登记时检测不到病毒载量对癫痫发作具有强烈的保护作用（OR0.03，p<0.001），而WHO第4期疾病史（OR2.2，p=0.05）或CD4计数<200（OR3.6，p<0.001）增加了癫痫发作的风险。
结论：早期开始抗逆转录病毒治疗和成功的病毒抑制可能会在很大程度上减轻HIV患儿的过多癫痫发作负担。
