Детские инфекции (Москва) (Oct 2023)
Improving the prediction of the immune status state dynamics in children with HIV infection
Abstract
The goal is to improve the prediction of the immune status state dynamics in children with HIV infection, taking into account the results of clinical and laboratory examination. Materials and methods. Clinical, immunological and molecular genetic examination was carried in 81 children with HIV infection at the age of median Me 22 months (interquartile interval of IQI 13—42 months). The duration of observation of patients was Me 10 months ( IQI 4—12 months). The time interval before the development of severe immunosuppression according to the WHO classification was determined. The criterion for severe immunosuppression was a decrease in the absolute number of CD4-lymphocytes less than 0.5 x 109/l, their relative number — less than 20%. To determine the factors influencing the rate of development of severe immunosuppression, mathematical models of the analysis of the time to the onset of the event (survival) and Cox proportional intensities were used. Results. Severe immunosuppression developed in 92.5% of children aged Me 32 months (IQI 17—54 months). Testing of clinical and laboratory parameters at the beginning of the study in mathematical models showed that statistical significance in the multifactorial model (P = 0.011) was demonstrated by the indicators «HIV blood viral load of 100 000 cop./ml or more» (odds ratio OR 3.1; 95% confidence interval 95% CI 1.9—10.2; P = 0.012), «Active form of cytomegalovirus infection» (OR 2.3; 95% CI 1.2—7.8; P = 0.026), «Active form of Epstein-Barr virus infection» (OR 2.0; 95% CI 1.1—4.6; P = 0.040). Conclusion. The vast majority of children with HIV infection (92.5%) at the age of Me 32 months ( IQI 17—54 months) developed severe immunosuppression. Independent factors that influenced the timing of severe immunosuppression development were the high rate of HIV replication and the presence of active forms of cytomegalovirus infection and Epstein-Barr virus infection. To prevent the progression of immunological disorders in children with HIV infection, it is necessary not only to prescribe antiretroviral therapy earlier, but also timely diagnosis and treatment of active forms of herpesvirus infections.
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