.Health Systems Research Unit, Medical Research Council, Tygerberg, Western Cape, South Africa.Department of International Maternal & Child Health Uppsala University, Uppsala, Sweden.School of Public Health, University of the Western Cape, Western Cape, South Africa.Department of Paediatrics and Child Health, University of Limpopo, MEDUNSA Campus, South Africa.
Acta Paediatr. 2010 May;99(5):694-698. doi: 10.1111/j.1651-2227.2009.01675.x. Epub 2010 Jan 19.
We sought to study the survival of newborn children according to HIV status of the mother, that of the child and the timing of infection.
This is a prospective cohort study of 883 mothers (665 HIV-positive and 218 HIV-negative) and their infants. Data were collected using semi-structured questionnaires during home visits between the antenatal period and 36 weeks post-delivery. Infant HIV status was determined at 3, 24 and 36 weeks by HIV DNA PCR.
The majority (81.3%) of infected infants who died were infected by 3 weeks of age. Of the HIV-exposed infants who died, 19 (28.4%) died before 6 weeks and 38 (56.7%) died by 12 weeks. The hazard ratio (HR) of mortality at 36 weeks of age in HIV-infected infants compared with exposed but negative infants was 8.9 (95% CI: 6.7-11.8). There was no significant difference in 36 week survival rates between HIV-non-exposed and HIV-exposed but negative infants (HR: 0.7; 95% CI: 0.3-1.5). The infant being HIV-positive at age 3 weeks (HR: 32 95% CI: 14.0-73.1) and rural site (HR: 4.4 95% CI: 1.2-23.4) were the two independent risk factors for infant death amongst HIV-exposed infants.
The prognosis for infants with early HIV infection was very poor in this cohort. A greater focus on prevention of early infection, earlier screening for HIV infection and access to antiretrovirals for eligible infants is recommended.
本研究旨在探讨母婴 HIV 状态、儿童 HIV 状态和感染时间对新生儿存活情况的影响。
这是一项前瞻性队列研究，共纳入 883 名母亲（665 名 HIV 阳性，218 名 HIV 阴性）及其婴儿。通过家访，在产前和产后 36 周期间，采用半结构化问卷收集数据。通过 HIV DNA PCR 在婴儿 3、24 和 36 周时检测 HIV 状态。
大多数（81.3%）死亡的感染婴儿在 3 周龄时就已感染。在死亡的 HIV 暴露婴儿中，19 名（28.4%）在 6 周龄前死亡，38 名（56.7%）在 12 周龄前死亡。与 HIV 阴性婴儿相比，感染 HIV 的婴儿在 36 周龄时的死亡风险比为 8.9（95%CI：6.7-11.8）。未感染 HIV 的婴儿与 HIV 暴露但未感染的婴儿在 36 周时的生存率没有显著差异（HR：0.7；95%CI：0.3-1.5）。3 周龄时婴儿 HIV 阳性（HR：32，95%CI：14.0-73.1）和农村地区（HR：4.4，95%CI：1.2-23.4）是 HIV 暴露婴儿死亡的两个独立危险因素。
在本队列中，早期 HIV 感染婴儿的预后非常差。建议更加重视预防早期感染，更早筛查 HIV 感染，并为符合条件的婴儿提供抗逆转录病毒药物。
