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Vol. 52. Núm. 2.
Páginas 138-147 (Febrero 2000)
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Vol. 52. Núm. 2.
Páginas 138-147 (Febrero 2000)
Acceso a texto completo
Manifestaciones clínicas y marcadores biológicos en la historia natural de la infección por el VIH-1 en niños infectados verticalmente. Estudio longitudinal
Clinical manifestations and biological markers in the natural history of hiv-1 infection. Longitudinal study
Visitas
...
S. Resinoa, J.M. Bellóna, J.L. Jiméneza, D. Gurbindob, M.A. Muñoz-Fernándeza,
Autor para correspondencia
Mmunoz@cbm.uam.es

Correspondencia: Dra. M.A. Muñoz-Fernández. Servicio de Inmunología. Hospital General Universitario Gregorio Marañón. Dr. Esquerdo, 46. 28007 Madrid.
a Servicio de Inmunología. Hospital Central Universitario Gregorio Marañón. Madrid.
b Sección de Inmuno-Pediatría. Hospital Central Universitario Gregorio Marañón. Madrid.
Información del artículo
Objetivo

Estudiar el valor predictivo de marcadores inmunológicos, virológicos y parámetros clínicos en la dinámica de progresión a muerte durante el seguimiento de una cohorte de 43 niños infectados por el VIH-1.

Pacientes y métodos

Estudio prospectivo en 43 niños infectados verticalmente por el VIH-1, menores de 12 meses de edad (rango, 0-11,80 meses) que no habían recibido tratamiento antiretroviral en el momento de su inclusión en el estudio. La cinética de replicación y el fenotipo de los aislados virales se determinó por cocultivo en CMSP y en MT-2, respectivamente. La carga viral se cuantificó en plasma utilizando el método estandarizado de RT-PCR de Roche. Las subpoblaciones linfocitarias se determinaron por citometría de flujo

Resultados

Realizamos un análisis multivariante de Cox, obteniendo un riesgo relativo de 6,42 (intervalo de confianza del 95%, 1,28-32,03); (p = 0,023) para los niños con una mediana de carga viral superior a 5 log10 copias/ml y de 6,84(intervalo de confianza del 95%, 1,52-30,69); (p = 0,012) para niños con cinética de replicación R/A. También estudiamos el valor predictivo de los síntomas clínicos y observamos que los síntomas con mayor valor predictivo de progresión a muerte fueron la encefalopatía progresiva (3,60 [IC 95%; 0,92-14,06; p = 0,065]) y la cardiopatía (6,29 [IC 95%: 1,59 - 24,85; p = 0,008]).

Conclusiones

Los marcadores inmunológicos y virológicos predictivos de progresión a muerte más importantes fueron la mediana de carga viral superior a 5 log10 y los aislados virales con cinética de replicación R/A a lo largo del estudio. Además, la encefalopatía progresiva y la cardiopatía se comportaron como marcadores independientes predictivos de progresión a muerte.

Palabras clave:
VIH-1
Niños
Carga viral
Fenotipo biológico
Linfocitos T CD4+
Supervivencia
Marcadores pronósticos
Objective

To study the relationship among clinical symptoms and biological markers as predictive value of progression to death in HIV-1 vertically infected infants

Patient and methods

We carry out a prospective study in 43 HIV-1 infants with a mean age of 4.27 (range: 0-11.8 months). None of the infant's mothers had received any antiviral treatment during pregnancy. None of the infants were breastfed. They were routinely assessed for clinical symptoms during follow-up

Results

Cox regression analysis was used to study the hazard ratio (HR) of progression to death. For the median viral load > 5 log10, the HR was 6.42 (95% CI, 1.28-32.03) (p = 0.023) and 6.84 (95% CI, 1.52-30,69) (p = 0.012) for biological phenotype of viral isolates with rapid replication and high titter (R/H-X4). We also study the predictive value of the clinical symptoms and we observe that the symptoms with more HR of progression to death were the progressive encephalopathy (3.60 [95% CI, 0.92-14.06; p = 0.065]) and the cardiopathy (6.29 [95% CI, 1.59-24.85; p = 0.008]).

Conclusions

Our data indicate that viral load > 5 log10 and biological phenotype R/H-X4 of virus isolates along the study are predictive markers of progression to death. In addition, the progressive encephalopathy and cardiopathy were also markers of progression death.

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