Odhiambo Collins, Zeh Clement, Ondoa Pascale, Omolo Paul, Akoth Benta, Lwamba Humphrey, Lando Richard, Williamson John, Otieno Juliana, Masaba Rose, Weidle Paul, Thomas Timothy
Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya.
Division of HIV/AIDS Prevention, U.S. Centers for Disease Control and Prevention (CDC), Kisumu, Kenya.
PLoS One. 2015 Nov 3;10(11):e0141599. doi: 10.1371/journal.pone.0141599. eCollection 2015.
Anemia results in increased morbidity and mortality, underscoring the need to better understand its pathophysiology amongst HIV-exposed and infected children in sub-Saharan Africa, the region where most infant HIV exposure and infections occur.
This analysis used samples obtained from children in the Kisumu Breastfeeding Study (KiBS). KiBS was a longitudinal phase IIB, open-label, one-arm clinical trial, designed to investigate the safety, tolerability and effectiveness of a maternal triple-antiretroviral (ARV) regimen for prevention of mother-to-child transmission (PMTCT) of HIV, during late pregnancy and early infancy while breastfeeding. Blood samples from 482 children were obtained at birth, 2, 6, 10 and 14 weeks and 6, 9, 12, 18 and 24 months. Severity of anemia was graded using the NIH Division of AIDS (DAIDS) toxicity tables. We describe the proportion of children with anemia and anomalies in red blood cell parameters at various time points over 24 months and compare rates of anemia between HIV-infected and HIV-uninfected children and by mothers' ARV regimen and infant malaria infection.
The proportion of children with anemia significantly increased after the breastfeeding period in both HIV-infected and HIV-uninfected children with higher proportion among HIV-infected children compared to HIV-uninfected children (RR: 1.72; CI: 1.22-2.44, p = 0.002). Maternal triple-antiretroviral regimen was not associated with infant anemia (p = 0.11). There was no significant difference in mean hemoglobin between HIV-uninfected children with and without malaria at each time point except at 24 months.
A relatively lower proportion of children with severe anemia during the breastfeeding period suggest that exposure to mother's triple antiretroviral combinations through breast milk, posed minimal risk of hematologic toxicity.
贫血会导致发病率和死亡率上升，这凸显了在撒哈拉以南非洲地区更好地了解暴露于艾滋病毒和感染艾滋病毒儿童的病理生理学的必要性，该地区是大多数婴儿暴露于艾滋病毒和感染艾滋病毒的发生地。
本分析使用了从基苏木母乳喂养研究（KiBS）中的儿童获取的样本。KiBS是一项纵向IIB期开放标签单臂临床试验，旨在研究母亲三联抗逆转录病毒（ARV）方案在妊娠晚期和婴儿早期母乳喂养期间预防艾滋病毒母婴传播（PMTCT）的安全性、耐受性和有效性。在出生时、2周、6周、10周、14周以及6个月、9个月、12个月、18个月和24个月时采集了482名儿童的血样。使用美国国立卫生研究院艾滋病司（DAIDS）毒性表对贫血严重程度进行分级。我们描述了24个月内不同时间点贫血儿童的比例以及红细胞参数异常情况，并比较了艾滋病毒感染儿童和未感染儿童之间以及根据母亲的抗逆转录病毒方案和婴儿疟疾感染情况的贫血发生率。
在母乳喂养期后，艾滋病毒感染儿童和未感染儿童中贫血儿童的比例均显著增加，且艾滋病毒感染儿童中的比例高于未感染儿童（相对危险度：1.72；可信区间：1.22 - 2.44，p = 0.002）。母亲三联抗逆转录病毒方案与婴儿贫血无关（p = 0.11）。除24个月外，在每个时间点，感染艾滋病毒且患疟疾的儿童与未患疟疾的儿童之间平均血红蛋白无显著差异。
母乳喂养期间重度贫血儿童比例相对较低，这表明通过母乳接触母亲的三联抗逆转录病毒组合造成血液学毒性的风险极小。
