评价 HIV 暴露但未感染婴儿在子宫内暴露于抗逆转录病毒药物后语言发育迟缓的风险。
Evaluation of risk for late language emergence after in utero antiretroviral drug exposure in HIV-exposed uninfected infants.
机构信息
From the *Speech, Language, Hearing Department, University of Kansas, Lawrence, KS; †Center for Biostatistics in AIDS Research, Harvard School of Public Health, Boston, MA; ‡Maternal and Pediatric Infectious Disease Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD; §Bronx-Lebanon Hospital Center, Albert Einstein College of Medicine, Bronx, NY; ¶Northwestern University Feinberg School of Medicine, Psychiatry and Behavioral Sciences, Chicago, IL; ‖Epidemiology and Statistics Program, Division of Scientific Programs, National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, MD; **Department of Research Pediatrics, Maternal, Child and Adolescent Program for Infectious Diseases and Virology, Keck School of Medicine of USC, Los Angeles, CA; ††Department of Pediatrics, Tulane University School of Medicine, New Orleans, LA; and ‡‡National Institute of Mental Health, National Institutes of Health, Bethesda, MD.
出版信息
Pediatr Infect Dis J. 2013 Oct;32(10):e406-13. doi: 10.1097/INF.0b013e31829b80ee.
BACKGROUND
Combination antiretroviral (cARV) regimens are recommended for pregnant women with HIV to prevent perinatal HIV transmission. Safety is a concern for infants who were HIV-exposed but uninfected, particularly for neurodevelopmental problems, such as language delays.
METHODS
We studied late language emergence (LLE) in HIV-exposed but uninfected children enrolled in a US-based prospective cohort study. LLE was defined as a caregiver-reported score ≤10th percentile in any of 4 domains of the MacArthur-Bates Communicative Development Inventory for 1-year olds and as ≥1 standard deviation below age-specific norms for the Ages and Stages Questionnaire for 2-year olds. Logistic regression models were used to evaluate associations of in utero cARV exposure with LLE, adjusting for infant, maternal and environmental characteristics.
RESULTS
1129 language assessments were conducted among 792 1- and 2-year-old children (50% male, 62% black and 37% Hispanic). Overall, 86% had in utero exposure to cARV and 83% to protease inhibitors. LLE was identified in 26% of 1-year olds and 23% of 2-year olds, with higher rates among boys. In adjusted models, LLE was not associated with maternal cARV or ARV drug classes in either age group. Among cARV-exposed 1-year olds, increased odds of LLE was observed for those exposed to atazanavir (adjusted odds ratio = 1.83, 95% confidence interval: 1.10-3.04), particularly after the first trimester (adjusted odds ratio = 3.56, P = 0.001), compared with atazanavir-unexposed infants. No associations of individual ARV drugs with LLE were observed among 2-year olds.
CONCLUSIONS
In utero cARV exposure showed little association with LLE, except for a higher risk of language delay observed in 1-year-old infants with atazanavir exposure.
背景
联合抗逆转录病毒（cARV）方案被推荐用于 HIV 感染的孕妇，以预防围产期 HIV 传播。对于 HIV 暴露但未感染的婴儿，安全性是一个关注点，特别是对于神经发育问题，如语言延迟。
方法
我们研究了在美国进行的一项前瞻性队列研究中 HIV 暴露但未感染的儿童中晚期语言出现延迟（LLE）。LLE 定义为在 1 岁时的麦克阿瑟 - 贝茨交际发展量表的任何 4 个领域中， caregiver 报告的得分≤第 10 个百分位数，或在 2 岁时的年龄和阶段问卷中，得分低于年龄特异性正常范围≥1 个标准差。使用逻辑回归模型评估胎儿 cARV 暴露与 LLE 的关联，同时调整婴儿、产妇和环境特征。
结果
在 792 名 1 岁和 2 岁儿童中进行了 1129 次语言评估（50%为男性，62%为黑人，37%为西班牙裔）。总体而言，86%的儿童在子宫内接触过 cARV，83%的儿童在子宫内接触过蛋白酶抑制剂。在 1 岁和 2 岁的儿童中，分别有 26%和 23%的儿童出现 LLE，男孩中 LLE 的发生率更高。在调整后的模型中，在这两个年龄组中，母亲的 cARV 或 ARV 药物类别与 LLE 均无关联。在接受阿扎那韦暴露的 1 岁儿童中，与未暴露于阿扎那韦的婴儿相比，LLE 的可能性增加（调整后的比值比=1.83，95%置信区间：1.10-3.04），尤其是在第一个孕期（调整后的比值比=3.56，P=0.001）。在 2 岁儿童中，未观察到任何 ARV 药物与 LLE 的关联。
结论
除了在接受阿扎那韦暴露的 1 岁婴儿中观察到更高的语言延迟风险外，胎儿 cARV 暴露与 LLE 之间的关联很小。
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