McGrath Nuala, Fawzi Wafaie W, Bellinger David, Robins James, Msamanga Gernard I, Manji Karim, Tronick Edward
Departments of Epidemiology, Harvard School of Public Health, Boston, MA, USA.
Pediatr Infect Dis J. 2006 Jan;25(1):47-52. doi: 10.1097/01.inf.0000195638.80578.e0.
To determine the association between the timing of mother-to-child transmission of human immunodeficiency virus (HIV)-1 and neurodevelopment among children born to HIV-1 infected mothers in Tanzania.
Bayley Scales of Infant Development (2nd edition) were administered at 6, 12 and 18 months to a subset of children (N = 327). Linear regression models and Cox proportional hazard models were separately fitted for the mental development index (MDI) and the psychomotor development index (PDI).
Children who tested HIV-1-positive at birth had significantly higher decreases per month in MDI and PDI than HIV-1-negative children; 1.1 [95% confidence interval (95% CI), 0.4, 1.8] for MDI and 1.4 (95% CI 0.0, 2.7] for PDI. Children who tested HIV-1-positive after birth had an additional 0.6 (95% CI 0.1, 1.1) point decrease in MDI per month and a 0.6 (95% CI 0.0, 1.1) higher decrease in PDI each month than HIV-1-negative children. Testing HIV-1-positive at birth was associated with a 14.9 (95% CI 5.0, 44.7) times higher rate of becoming developmentally delayed in mental function, while testing HIV-1-positive after birth was associated with a 3.2 (95% CI 1.6, 6.4) times higher rate than in uninfected children.
HIV-1 infected infants performed worse on tests of neurodevelopment and were significantly more likely to be identified as developmentally delayed in the first 18 months of life than HIV-1-negative children. The effect of HIV-1 infection on neurodevelopment scores and the risk of developmental delay may be highest among those who are already HIV-1 infected at birth.
确定坦桑尼亚感染人类免疫缺陷病毒1型（HIV-1）的母亲将病毒母婴传播的时间与孩子神经发育之间的关联。
对部分儿童（N = 327）在6个月、12个月和18个月时进行贝利婴儿发育量表（第二版）测试。分别针对智力发育指数（MDI）和心理运动发育指数（PDI）拟合线性回归模型和Cox比例风险模型。
出生时HIV-1检测呈阳性的儿童，其MDI和PDI每月的下降幅度显著高于HIV-1检测呈阴性的儿童；MDI为1.1 [95%置信区间（95%CI），0.4，1.8]，PDI为1.4（95%CI 0.0，2.7]。出生后HIV-1检测呈阳性的儿童，其MDI每月比HIV-1检测呈阴性的儿童额外下降0.6（95%CI 0.1，1.1）分，PDI每月下降幅度比HIV-1检测呈阴性的儿童高0.6（95%CI 0.0，1.1）。出生时HIV-1检测呈阳性与智力功能发育延迟发生率高出14.9（95%CI 5.0，44.7）倍相关，而出生后HIV-1检测呈阳性与未感染儿童相比，发生率高出3.2（95%CI 1.6，6.4）倍。
与HIV-1检测呈阴性的儿童相比，感染HIV-1的婴儿在神经发育测试中的表现更差，在生命的前18个月被认定为发育延迟的可能性显著更高。HIV-1感染对神经发育评分和发育延迟风险的影响在出生时就已感染HIV-1的儿童中可能最大。
