Feiterna-Sperling Cornelia, Weizsaecker Katharina, Bührer Christoph, Casteleyn Simone, Loui Andrea, Schmitz Thomas, Wahn Volker, Obladen Michael
Charité, Department of Pediatric Pneumology and Immunology, University Medicine Berlin, Berlin, Germany.
J Acquir Immune Defic Syndr. 2007 May 1;45(1):43-51. doi: 10.1097/QAI.0b013e318042d5e3.
A prospective observational study to investigate hematologic alterations during the first 3 months of life in HIV-exposed uninfected infants subjected to antiretroviral medication before and after birth.
Two hundred twenty-one consecutive uninfected infants born to HIV-positive mothers on antiretroviral medication during pregnancy were included. Perinatal transmission prophylaxis comprised zidovudine (ZDV) administered intravenously intrapartum and 10 days after birth. Blood counts and differentials were determined at birth and at 2, 4, 6, and 12 weeks of age, and hematologic toxicity was graded according to pediatric toxicity scales. Data were analyzed according to the kind of prenatal medication (ZDV alone or with another nucleoside reverse transcriptase inhibitor [NRTI] vs. highly active antiretroviral therapy [HAART]).
Median hemoglobin was significantly lower in HAART-exposed newborns from birth (P = 0.004) until day 28. During follow-up, 119 (53.8%) infants had anemia grade 2 or higher on at least 1 occasion; 16 (7.2%) received red blood cell transfusion at 23 (range: 1-56) days of age. Neutropenia grade 2 or higher occurred in 106 (48.0%) infants at least once; 8 infants had staphylococcal infections, and 2 infections were severe. After adjustment for possible confounders (prematurity, birth weight, ethnicity, gender, duration of maternal antiretroviral therapy, maternal Centers for Disease Control and Prevention stage, and maternal illicit drug use), HAART exposure was the only independent risk factor for anemia (odds ratio [OR] = 2.22, 95% confidence interval [CI]: 1.06 to 4.64; P = 0.034) and neutropenia (OR = 2.15, CI: 1.02 to 4.55; P = 0.045).
Antiretroviral transmission prophylaxis is associated with significant anemia and neutropenia in HIV-uninfected infants during the first 3 months of life. Anemia was more profound in HAART-exposed infants.
一项前瞻性观察性研究，旨在调查在出生前后接受抗逆转录病毒药物治疗的暴露于HIV但未感染的婴儿出生后头3个月内的血液学改变。
纳入221例连续出生的婴儿，其母亲为HIV阳性且在孕期接受抗逆转录病毒药物治疗。围产期传播预防措施包括在分娩时静脉注射齐多夫定（ZDV）以及在出生后10天使用该药。在出生时以及2、4、6和12周龄时测定血细胞计数和分类，并根据儿科毒性量表对血液学毒性进行分级。根据产前用药类型（单独使用ZDV或与另一种核苷类逆转录酶抑制剂[NRTI]联用与高效抗逆转录病毒治疗[HAART]）对数据进行分析。
从出生到第28天，暴露于HAART的新生儿的血红蛋白中位数显著较低（P = 0.004）。在随访期间，119例（53.8%）婴儿至少有1次出现2级或更高等级的贫血；16例（7.2%）在23天（范围：1 - 56天）龄时接受了红细胞输血。106例（48.0%）婴儿至少有1次出现2级或更高等级的中性粒细胞减少；8例婴儿发生葡萄球菌感染，其中2例感染严重。在对可能的混杂因素（早产、出生体重、种族、性别、母亲抗逆转录病毒治疗持续时间、母亲疾病控制和预防中心分期以及母亲使用非法药物情况）进行调整后，暴露于HAART是贫血（优势比[OR] = 2.22，95%置信区间[CI]：1.06至4.64；P = 0.034）和中性粒细胞减少（OR = 2.15，CI：1.02至4.55；P = 0.045）的唯一独立危险因素。
抗逆转录病毒传播预防措施与暴露于HIV但未感染的婴儿出生后头3个月内显著的贫血和中性粒细胞减少有关。暴露于HAART的婴儿贫血更为严重。
