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Prevalence and Clinical Outcomes of Poor Immune Response Despite Virologically Suppressive Antiretroviral Therapy Among Children and Adolescents With Human Immunodeficiency Virus in Europe and Thailand: Cohort Study.
Clinical Infectious Diseases ( IF 8.2 ) Pub Date : 2020-01-16 , DOI: 10.1093/cid/ciz253 , Elizabeth Chappell , Andrew Riordan , Gonzague Jourdain , Antoni Soriano-Arandes , Luminita Ene , Henriette J Scherpbier , Josiane Warszawski , Intira J Collins , Colette Smit , Laura Marques , Nigel Klein , Sara Guillén , Ali Judd , Claire Thorne , Ruth Goodall , Christoph Königs , Vana Spoulou , Filipa Prata , Tessa Goetghebuer , Elena Chiappini , Luisa Galli , Lars Naver , Carlo Giaquinto , Diana M Gibb , Magdalena Marczynska , Liubov Okhonskaia , Thomas Klimkait , Marc Lallemant , Nicole Ngo-Giang-Huong , Galyna Kiseleva , Ruslan Malyuta , Alla Volokha , Tessa Goetghebuer , Marc Hainaut , Marc Delforge , Josiane Warszawski , Jerome Le Chenadec , Elisa Ramos , Olivia Dialla , Thierry Wack , Corine Laurent , Lamya Ait si Selmi , Isabelle Leymarie , Fazia Ait Benali , Maud Brossard , Leila Boufassa , Corinne Floch-Tudal , Ghislaine Firtion , Isabelle Hau , Anne Chace , Pascal Bolot , Stéphane Blanche , Martine Levine , Le Kremlin Bicëtre , Corinne Fourcade , Brigitte Heller-Roussin , Camille Runel-Belliard , Joëlle Tricoire , Catherine Chirouze , Véronique Reliquet , Jacques Brouard , Kamila Kebaili , Pascale Fialaire , Muriel Lalande , Christoph Königs , Stephan Schultze-Strasser , U Baumann , T Niehues , J Neubert , R Kobbe , Charite Berlin , C Feiterna-Sperling , C Königs , B Buchholz , G Notheis , Vana Spoulou , Maurizio de Martino , Pier Angelo Tovo , Osimani Patrizia , Domenico Larovere , Maurizio Ruggeri , Giacomo Faldella , Francesco Baldi , Raffaele Badolato , Carlotta Montagnani , Elisabetta Venturini , Catiuscia Lisi , Antonio Di Biagio , Lucia Taramasso , Vania Giacomet , Paola Erba , Susanna Esposito , Rita Lipreri , Filippo Salvini , Claudia Tagliabue , Monica Cellini , Eugenia Bruzzese , Andrea Lo Vecchio , Osvalda Rampon , Daniele Donà , Amelia Romano , Icilio Dodi , Anna Maccabruni , Rita Consolini , Stefania Bernardi , Hyppolite Tchidjou Kuekou , Orazio Genovese , Paolina Olmeo , Letizia Cristiano , Antonio Mazza , Clara Gabiano , Silvia Garazzino , Antonio Pellegatta , D Pajkrt , H J Scherpbier , A M Weijsenfeld , C G de Boer , S Jurriaans , N K T Back , H L Zaaijer , B Berkhout , M T E Cornelissen , C J Schinkel , K C Wolthers , P L A Fraaij , A M C van Rossum , L C van der Knaap , E G Visser , M P G Koopmans , J J A van Kampen , S D Pas , S S V Henriet , M van de Flier , K van Aerde , R Strik-Albers , J Rahamat-Langendoen , F F Stelma , E H Schölvinck , H de Groot-de Jonge , H G M Niesters , C C van Leer-Buter , M Knoester , L J Bont , S P M Geelen , T F W Wolfs , N Nauta , C W Ang , R van Houdt , A M Pettersson , C M J E Vandenbroucke-Grauls , P Reiss , D O Bezemer , A I van Sighem , C Smit , F W M N Wit , T S Boender , S Zaheri , M Hillebregt , A de Jong , D Bergsma , S Grivell , A Jansen , M Raethke , R Meijering , L de Groot , M van den Akker , Y Bakker , E Claessen , A El Berkaoui , J Koops , E Kruijne , C Lodewijk , L Munjishvili , B Peeck , C Ree , R Regtop , Y Ruijs , T Rutkens , M Schoorl , A Timmerman , E Tuijn , L Veenenberg , S van der Vliet , A Wisse , T Woudstra , B Tuk , Jolanta Popielska , Maria Pokorska-Śpiewak , Agnieszka Ołdakowska , Konrad Zawadka , Urszula Coupland , Małgorzata DorobaLaura Marques , Carla Teixeira , Alexandre Fernandes , Filipa Prata , Luminita Ene , Liubov Okhonskaia , Evgeny Voronin , Milana Miloenko , Svetlana Labutina , José Tomás Ramos , Luis Prieto , Sara Guillén , María Luisa Navarro , Jesús Saavedra , Mar Santos , Mª Angeles Muñoz , Beatriz Ruiz , Carolina Fernandez Mc Phee , Santiago Jimenez de Ory , Susana Alvarez , Miguel Ángel Roa , José Beceiro , Jorge Martínez , Katie Badillo , Miren Apilanez , Itziar Pocheville , Elisa Garrote , Elena Colino , Jorge Gómez Sirvent , Mónica Garzón , Vicente Román , Abián Montesdeoca , Mercedes Mateo , María José Muñoz , Raquel Angulo , Olaf Neth , Lola Falcón , Pedro Terol , Juan Luis Santos , David Moreno , Francisco Lendínez , Ana Grande , Francisco José Romero , Miguel Lillo , Begoña Losada , Mercedes Herranz , Matilde Bustillo , Carmelo Guerrero , Pilar Collado , José Antonio Couceiro , Amparo Pérez , Ana Isabel Piqueras , Rafael Bretón , Inmaculada Segarra , César Gavilán , Enrique Jareño , Elena Montesinos , Marta Dapena , Cristina Álvarez , Ana Gloria Andrés , Víctor Marugán , Carlos Ochoa , Santiago Alfayate , Ana Isabel Menasalvas , Elisa de Miguel , K Aebi-Popp , S Asner , V Aubert , M Battegay , M Baumann , E Bernasconi , J Böni , P Brazzola , H C Bucher , A Calmy , M Cavassini , A Ciuffi , A Duppenthaler , G Dollenmaier , M Egger , L Elzi , J Fehr , J Fellay , K Francini , H Furrer , C A Fux , C Grawe , H F Günthard , D Haerry , B Hasse , H H Hirsch , M Hoffmann , I Hösli , C Kahlert , L Kaiser , O Keiser , T Klimkait , H Kovari , R D Kouyos , B Ledergerber , G Martinetti , B Martinez de Tejada , K J Metzner , N Müller , D Nicca , P Paioni , G Pantaleo , Ch Polli , K Posfay-Barbe , A Rauch , C Rudin , P Schmid , A U Scherrer , R Speck , P Tarr , M Thanh Lecompte , A Trkola , P Vernazza , N Wagner , G Wandeler , R Weber , C A Wyler , S Yerly , Pornchai Techakunakorn , Rawiwan Hansudewechakul , Chiang Kham , Vanichaya Wanchaitanawong , Sookchai Theansavettrakul , Mae Sai , Sirisak Nanta , Chaiwat Ngampiyaskul , Siriluk Phanomcheong , Suchat Hongsiriwon , Warit Karnchanamayul , Ratchanee Kwanchaipanich , Suparat Kanjanavanit , Nareerat Kamonpakorn , Maneeratn Nantarukchaikul , Prapaisri Layangool , Jutarat Mekmullica , Paiboon Lucksanapisitkul , Sudarat Watanayothin , Narong Lertpienthum , Boonyarat Warachit , Sansanee Hanpinitsak , Sathit Potchalongsin , Pimpraphai Thanasiri , Sawitree Krikajornkitti , Pornsawan Attavinijtrakarn , Sakulrat Srirojana , Suthunya Bunjongpak , Achara Puangsombat , Sathaporn Na-Rajsima , Pornchai Ananpatharachai , Noppadon Akarathum , Vachira Phuket , Weerasak Lawtongkum , Prapawan Kheunjan , Thitiporn Suriyaboon , Airada Saipanya , Kanchana Than-in-at , Nirattiya Jaisieng , Rapeepan Suaysod , Sanuphong Chailoet , Naritsara Naratee , Suttipong Kawilapat , T Kaleeva , Y Baryshnikova , S Soloha , N Bashkatova , I Raus , O Glutshenko , Z Ruban , N Prymak , G Kiseleva , H Bailey , Alasdair Bamford , Karina Butler , Katja Doerholt , Conor Doherty , Caroline Foster , Kate Francis , Ian Harrison , Julia Kenny , Nigel Klein , Gillian Letting , Paddy McMaster , Fungai Murau , Edith Nsangi , Helen Peters , Katia Prime , Andrew Riordan , Fiona Shackley , Delane Shingadia , Sharon Storey , Claire Thorne , Gareth Tudor-Williams , Anna Turkova , Steve Welch , Intira Jeannie Collins , Claire Cook , Siobhan Crichton , Donna Dobson , Keith Fairbrother , Diana M Gibb , Lynda Harper , Ali Judd , Marthe Le Prevost , Nadine Van Looy , Helen Peters , Claire Thorne , K Butler , A Walsh , L Thrasyvoulou , S Welch , J Bernatoniene , F Manyika , G Sharpe , B Subramaniam , K Sloper , K Fidler , R Hague , V Price , M Clapson , J Flynn , A Cardoso , M Abou-Rayyah , N Klein , D Shingadia , D Gurtin , S Yeadon , S SegalC Ball , S Hawkins , M Dowie , S Bandi , E Percival , M Eisenhut , K Duncan , S Clough , L Anguvaa , S Conway , T Flood , A Pickering , P McMaster , C Murphy , J Daniels , Y Lees , F Thompson , B Williams , S Pope , L Cliffe , A Smyth , S Southall , A Freeman , H Freeman , S Christie , A Gordon , D Rogahn , L Clarke , L Jones , B Offerman , M Greenberg , C Benson , A Riordan , L Ibberson , F Shackley , S N Faust , J Hancock , K Doerholt , K Prime , M Sharland , S Storey , H Lyall , C Monrose , P Seery , G Tudor-Williams , E Menson , A Callaghan , A Bridgwood , P McMaster , J Evans , E Blake , A Yannoulias , Elizabeth Chappell , Siobhan Critchton , Intira Jeannie Collins , Charlotte Duff , Carlo Giaquinto , Ruth Goodall , Daniel Gomezpena , Ali Judd , Rebecca Lundin , Laura Mangiarini , Alessandra Nardone , Claire Thorne
Clinical Infectious Diseases ( IF 8.2 ) Pub Date : 2020-01-16 , DOI: 10.1093/cid/ciz253 , Elizabeth Chappell , Andrew Riordan , Gonzague Jourdain , Antoni Soriano-Arandes , Luminita Ene , Henriette J Scherpbier , Josiane Warszawski , Intira J Collins , Colette Smit , Laura Marques , Nigel Klein , Sara Guillén , Ali Judd , Claire Thorne , Ruth Goodall , Christoph Königs , Vana Spoulou , Filipa Prata , Tessa Goetghebuer , Elena Chiappini , Luisa Galli , Lars Naver , Carlo Giaquinto , Diana M Gibb , Magdalena Marczynska , Liubov Okhonskaia , Thomas Klimkait , Marc Lallemant , Nicole Ngo-Giang-Huong , Galyna Kiseleva , Ruslan Malyuta , Alla Volokha , Tessa Goetghebuer , Marc Hainaut , Marc Delforge , Josiane Warszawski , Jerome Le Chenadec , Elisa Ramos , Olivia Dialla , Thierry Wack , Corine Laurent , Lamya Ait si Selmi , Isabelle Leymarie , Fazia Ait Benali , Maud Brossard , Leila Boufassa , Corinne Floch-Tudal , Ghislaine Firtion , Isabelle Hau , Anne Chace , Pascal Bolot , Stéphane Blanche , Martine Levine , Le Kremlin Bicëtre , Corinne Fourcade , Brigitte Heller-Roussin , Camille Runel-Belliard , Joëlle Tricoire , Catherine Chirouze , Véronique Reliquet , Jacques Brouard , Kamila Kebaili , Pascale Fialaire , Muriel Lalande , Christoph Königs , Stephan Schultze-Strasser , U Baumann , T Niehues , J Neubert , R Kobbe , Charite Berlin , C Feiterna-Sperling , C Königs , B Buchholz , G Notheis , Vana Spoulou , Maurizio de Martino , Pier Angelo Tovo , Osimani Patrizia , Domenico Larovere , Maurizio Ruggeri , Giacomo Faldella , Francesco Baldi , Raffaele Badolato , Carlotta Montagnani , Elisabetta Venturini , Catiuscia Lisi , Antonio Di Biagio , Lucia Taramasso , Vania Giacomet , Paola Erba , Susanna Esposito , Rita Lipreri , Filippo Salvini , Claudia Tagliabue , Monica Cellini , Eugenia Bruzzese , Andrea Lo Vecchio , Osvalda Rampon , Daniele Donà , Amelia Romano , Icilio Dodi , Anna Maccabruni , Rita Consolini , Stefania Bernardi , Hyppolite Tchidjou Kuekou , Orazio Genovese , Paolina Olmeo , Letizia Cristiano , Antonio Mazza , Clara Gabiano , Silvia Garazzino , Antonio Pellegatta , D Pajkrt , H J Scherpbier , A M Weijsenfeld , C G de Boer , S Jurriaans , N K T Back , H L Zaaijer , B Berkhout , M T E Cornelissen , C J Schinkel , K C Wolthers , P L A Fraaij , A M C van Rossum , L C van der Knaap , E G Visser , M P G Koopmans , J J A van Kampen , S D Pas , S S V Henriet , M van de Flier , K van Aerde , R Strik-Albers , J Rahamat-Langendoen , F F Stelma , E H Schölvinck , H de Groot-de Jonge , H G M Niesters , C C van Leer-Buter , M Knoester , L J Bont , S P M Geelen , T F W Wolfs , N Nauta , C W Ang , R van Houdt , A M Pettersson , C M J E Vandenbroucke-Grauls , P Reiss , D O Bezemer , A I van Sighem , C Smit , F W M N Wit , T S Boender , S Zaheri , M Hillebregt , A de Jong , D Bergsma , S Grivell , A Jansen , M Raethke , R Meijering , L de Groot , M van den Akker , Y Bakker , E Claessen , A El Berkaoui , J Koops , E Kruijne , C Lodewijk , L Munjishvili , B Peeck , C Ree , R Regtop , Y Ruijs , T Rutkens , M Schoorl , A Timmerman , E Tuijn , L Veenenberg , S van der Vliet , A Wisse , T Woudstra , B Tuk , Jolanta Popielska , Maria Pokorska-Śpiewak , Agnieszka Ołdakowska , Konrad Zawadka , Urszula Coupland , Małgorzata DorobaLaura Marques , Carla Teixeira , Alexandre Fernandes , Filipa Prata , Luminita Ene , Liubov Okhonskaia , Evgeny Voronin , Milana Miloenko , Svetlana Labutina , José Tomás Ramos , Luis Prieto , Sara Guillén , María Luisa Navarro , Jesús Saavedra , Mar Santos , Mª Angeles Muñoz , Beatriz Ruiz , Carolina Fernandez Mc Phee , Santiago Jimenez de Ory , Susana Alvarez , Miguel Ángel Roa , José Beceiro , Jorge Martínez , Katie Badillo , Miren Apilanez , Itziar Pocheville , Elisa Garrote , Elena Colino , Jorge Gómez Sirvent , Mónica Garzón , Vicente Román , Abián Montesdeoca , Mercedes Mateo , María José Muñoz , Raquel Angulo , Olaf Neth , Lola Falcón , Pedro Terol , Juan Luis Santos , David Moreno , Francisco Lendínez , Ana Grande , Francisco José Romero , Miguel Lillo , Begoña Losada , Mercedes Herranz , Matilde Bustillo , Carmelo Guerrero , Pilar Collado , José Antonio Couceiro , Amparo Pérez , Ana Isabel Piqueras , Rafael Bretón , Inmaculada Segarra , César Gavilán , Enrique Jareño , Elena Montesinos , Marta Dapena , Cristina Álvarez , Ana Gloria Andrés , Víctor Marugán , Carlos Ochoa , Santiago Alfayate , Ana Isabel Menasalvas , Elisa de Miguel , K Aebi-Popp , S Asner , V Aubert , M Battegay , M Baumann , E Bernasconi , J Böni , P Brazzola , H C Bucher , A Calmy , M Cavassini , A Ciuffi , A Duppenthaler , G Dollenmaier , M Egger , L Elzi , J Fehr , J Fellay , K Francini , H Furrer , C A Fux , C Grawe , H F Günthard , D Haerry , B Hasse , H H Hirsch , M Hoffmann , I Hösli , C Kahlert , L Kaiser , O Keiser , T Klimkait , H Kovari , R D Kouyos , B Ledergerber , G Martinetti , B Martinez de Tejada , K J Metzner , N Müller , D Nicca , P Paioni , G Pantaleo , Ch Polli , K Posfay-Barbe , A Rauch , C Rudin , P Schmid , A U Scherrer , R Speck , P Tarr , M Thanh Lecompte , A Trkola , P Vernazza , N Wagner , G Wandeler , R Weber , C A Wyler , S Yerly , Pornchai Techakunakorn , Rawiwan Hansudewechakul , Chiang Kham , Vanichaya Wanchaitanawong , Sookchai Theansavettrakul , Mae Sai , Sirisak Nanta , Chaiwat Ngampiyaskul , Siriluk Phanomcheong , Suchat Hongsiriwon , Warit Karnchanamayul , Ratchanee Kwanchaipanich , Suparat Kanjanavanit , Nareerat Kamonpakorn , Maneeratn Nantarukchaikul , Prapaisri Layangool , Jutarat Mekmullica , Paiboon Lucksanapisitkul , Sudarat Watanayothin , Narong Lertpienthum , Boonyarat Warachit , Sansanee Hanpinitsak , Sathit Potchalongsin , Pimpraphai Thanasiri , Sawitree Krikajornkitti , Pornsawan Attavinijtrakarn , Sakulrat Srirojana , Suthunya Bunjongpak , Achara Puangsombat , Sathaporn Na-Rajsima , Pornchai Ananpatharachai , Noppadon Akarathum , Vachira Phuket , Weerasak Lawtongkum , Prapawan Kheunjan , Thitiporn Suriyaboon , Airada Saipanya , Kanchana Than-in-at , Nirattiya Jaisieng , Rapeepan Suaysod , Sanuphong Chailoet , Naritsara Naratee , Suttipong Kawilapat , T Kaleeva , Y Baryshnikova , S Soloha , N Bashkatova , I Raus , O Glutshenko , Z Ruban , N Prymak , G Kiseleva , H Bailey , Alasdair Bamford , Karina Butler , Katja Doerholt , Conor Doherty , Caroline Foster , Kate Francis , Ian Harrison , Julia Kenny , Nigel Klein , Gillian Letting , Paddy McMaster , Fungai Murau , Edith Nsangi , Helen Peters , Katia Prime , Andrew Riordan , Fiona Shackley , Delane Shingadia , Sharon Storey , Claire Thorne , Gareth Tudor-Williams , Anna Turkova , Steve Welch , Intira Jeannie Collins , Claire Cook , Siobhan Crichton , Donna Dobson , Keith Fairbrother , Diana M Gibb , Lynda Harper , Ali Judd , Marthe Le Prevost , Nadine Van Looy , Helen Peters , Claire Thorne , K Butler , A Walsh , L Thrasyvoulou , S Welch , J Bernatoniene , F Manyika , G Sharpe , B Subramaniam , K Sloper , K Fidler , R Hague , V Price , M Clapson , J Flynn , A Cardoso , M Abou-Rayyah , N Klein , D Shingadia , D Gurtin , S Yeadon , S SegalC Ball , S Hawkins , M Dowie , S Bandi , E Percival , M Eisenhut , K Duncan , S Clough , L Anguvaa , S Conway , T Flood , A Pickering , P McMaster , C Murphy , J Daniels , Y Lees , F Thompson , B Williams , S Pope , L Cliffe , A Smyth , S Southall , A Freeman , H Freeman , S Christie , A Gordon , D Rogahn , L Clarke , L Jones , B Offerman , M Greenberg , C Benson , A Riordan , L Ibberson , F Shackley , S N Faust , J Hancock , K Doerholt , K Prime , M Sharland , S Storey , H Lyall , C Monrose , P Seery , G Tudor-Williams , E Menson , A Callaghan , A Bridgwood , P McMaster , J Evans , E Blake , A Yannoulias , Elizabeth Chappell , Siobhan Critchton , Intira Jeannie Collins , Charlotte Duff , Carlo Giaquinto , Ruth Goodall , Daniel Gomezpena , Ali Judd , Rebecca Lundin , Laura Mangiarini , Alessandra Nardone , Claire Thorne
BACKGROUND
In human immunodeficiency virus (HIV)-positive adults, low CD4 cell counts despite fully suppressed HIV-1 RNA on antiretroviral therapy (ART) have been associated with increased risk of morbidity and mortality. We assessed the prevalence and outcomes of poor immune response (PIR) in children receiving suppressive ART.
METHODS
Sixteen cohorts from the European Pregnancy and Paediatric HIV Cohort Collaboration (EPPICC) contributed data. Children <18 years at ART initiation, with sustained viral suppression (VS) (≤400 copies/mL) for ≥1 year were included. The prevalence of PIR (defined as World Health Organization advanced/severe immunosuppression for age) at 1 year of VS was described. Factors associated with PIR were assessed using logistic regression. Rates of acquired immunodeficiency syndrome (AIDS) or death on suppressive ART were calculated by PIR status.
RESULTS
Of 2318 children included, median age was 6.4 years and 68% had advanced/severe immunosuppression at ART initiation. At 1 year of VS, 12% had PIR. In multivariable analysis, PIR was associated with older age and worse immunological stage at ART start, hepatitis B coinfection, and residing in Thailand (all P ≤ .03). Rates of AIDS/death (95% confidence interval) per 100 000 person-years were 1052 (547, 2022) among PIR versus 261 (166, 409) among immune responders; rate ratio of 4.04 (1.83, 8.92; P < .001).
CONCLUSIONS
One in eight children in our cohort experienced PIR despite sustained VS. While the overall rate of AIDS/death was low, children with PIR had a 4-fold increase in risk of event as compared with immune responders.
中文翻译：
在欧洲和泰国，尽管对儿童和青少年人免疫缺陷病毒进行了病毒学抑制性抗逆转录病毒疗法，但免疫反应较差的患病率和临床结果：队列研究。
背景技术在人类免疫缺陷病毒（HIV）阳性成年人中，尽管抗逆转录病毒疗法（ART）完全抑制了HIV-1 RNA，但CD4细胞计数低却与发病率和死亡率增加有关。我们评估了接受抑制性抗逆转录病毒治疗的儿童中不良免疫反应（PIR）的患病率和结果。方法来自欧洲妊娠和儿童HIV队列合作组织（EPPICC）的16个队列提供了数据。纳入抗病毒治疗开始时<18岁的儿童，且持续病毒抑制（VS）（≤400拷贝/ mL）≥1年。描述了VS 1年时PIR的患病率（定义为世界卫生组织的晚期严重免疫抑制）。使用logistic回归评估与PIR相关的因素。通过PIR状态计算获得性免疫缺陷综合症（AIDS）或抑制性ART死亡率。结果纳入的2318名儿童中位年龄为6.4岁，其中68％的儿童在接受抗逆转录病毒治疗时具有晚期/严重的免疫抑制作用。在VS的1年时，有12％的人有PIR。在多变量分析中，PIR与ART开始，乙型肝炎合并感染和泰国居住时年龄较大和免疫学阶段较差有关（所有P≤.03）。每10万人年的艾滋病/死亡（95％置信区间）比率在PIR中为1052（547，2022），而在免疫应答者中为261（166，409）；比率为4.04（1.83，8.92; P <.001）。结论尽管有持续性VS，我们队列中八分之一的儿童仍经历了PIR。尽管艾滋病/死亡的总体发生率较低，但与免疫反应者相比，PIR儿童的事件风险增加了4倍。
更新日期：2020-01-16
中文翻译：
在欧洲和泰国，尽管对儿童和青少年人免疫缺陷病毒进行了病毒学抑制性抗逆转录病毒疗法，但免疫反应较差的患病率和临床结果：队列研究。
背景技术在人类免疫缺陷病毒（HIV）阳性成年人中，尽管抗逆转录病毒疗法（ART）完全抑制了HIV-1 RNA，但CD4细胞计数低却与发病率和死亡率增加有关。我们评估了接受抑制性抗逆转录病毒治疗的儿童中不良免疫反应（PIR）的患病率和结果。方法来自欧洲妊娠和儿童HIV队列合作组织（EPPICC）的16个队列提供了数据。纳入抗病毒治疗开始时<18岁的儿童，且持续病毒抑制（VS）（≤400拷贝/ mL）≥1年。描述了VS 1年时PIR的患病率（定义为世界卫生组织的晚期严重免疫抑制）。使用logistic回归评估与PIR相关的因素。通过PIR状态计算获得性免疫缺陷综合症（AIDS）或抑制性ART死亡率。结果纳入的2318名儿童中位年龄为6.4岁，其中68％的儿童在接受抗逆转录病毒治疗时具有晚期/严重的免疫抑制作用。在VS的1年时，有12％的人有PIR。在多变量分析中，PIR与ART开始，乙型肝炎合并感染和泰国居住时年龄较大和免疫学阶段较差有关（所有P≤.03）。每10万人年的艾滋病/死亡（95％置信区间）比率在PIR中为1052（547，2022），而在免疫应答者中为261（166，409）；比率为4.04（1.83，8.92; P <.001）。结论尽管有持续性VS，我们队列中八分之一的儿童仍经历了PIR。尽管艾滋病/死亡的总体发生率较低，但与免疫反应者相比，PIR儿童的事件风险增加了4倍。
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