Causes of Acute Hospitalization in Adolescence Burden and Spectrum of HIV-Related Morbidity in a Country with an Early-Onset and Severe HIV Epidemic A Prospective Survey 英文参考文献.docVIP

CausesofAcuteHospitalizationinAdolescence:Burden andSpectrumofHIV-RelatedMorbidityinaCountrywith anEarly-OnsetandSevereHIVEpidemic:AProspective Survey RashidaA.Ferrand1,2*,TsitsiBandason2,PraiseMusvaire2,NatashaLarke1,KusumNathoo3 ,Hilda Mujuru3,ChiratidzoE.Ndhlovu3,ShunguMunyati2,FrancesM.Cowan4,DianaM.Gibb5,ElizabethL. Corbett1,2 1London SchoolofHygieneTropicalMedicine,London,United Kingdom,2BiomedicalResearchTraining Institute,Harare,Zimbabwe, 3UniversityofZimbabwe, Harare,Zimbabwe,4UniversityCollegeLondon,London,UnitedKingdom,5MedicalResearchCouncilClinicalTrialsUnit,London,UnitedKingdom Abstract Background:Survivaltoolderchildhoodwithuntreated,verticallyacquiredHIVinfection,whichwaspreviouslyconsidered extremelyunusual,isincreasinglywelldescribed.However,theoverallimpactonadolescenthealthinsettingswithhigh HIVseroprevalencehasnotpreviouslybeeninvestigated. Methods and Findings: Adolescents (aged 10–18y) systematically recruited from acute admissions to the two public hospitalsinHarare,Zimbabwe,answeredaquestionnaireandunderwentstandardinvestigationsincludingHIVtesting,with consent.Pre-setcase-definitionsdefinedcauseofadmissionandunderlyingchronicconditions.Participationwas94%.139 (46%)of301participantswereHIV-positive(medianageofdiagnosis12y:interquartilerange[IQR]11–14y),medianCD4 count=151;IQR57–328cells/ml),butonlyfour(1.3%)wereherpessimplexvirus-2(HSV-2)positive.Age(median13y:IQR 11–16y)andsex(57%male)didnotdifferbyHIVstatus,butHIV-infectedparticipantsweresignificantlymorelikelytobe stunted(z-score,22:52%versus23%,p,0.001),havepubertaldelay(15%versus2%,p,0.001),andbematernalorphans orhaveanHIV-infectedmother(73%versus17%,p,0.001).69%ofHIV-positiveand19%ofHIV-negativeadmissionswere for infections, most commonly tuberculosis and pneumonia. 84 (28%) participants had underlying heart, lung, or other chronic diseases. Case fatality rates were significantly higher for HIV-related admissions (22% versus 7%, p,0.001), and significantlyassociatedwithadvance