Brennan Alana T, Bonawitz Rachael, Gill Christopher J, Thea Donald M, Kleinman Mary, Useem Johanna, Garrison Lindsey, Ceccarelli Rachel, Udokwu Chinenye, Long Lawrence, Fox Matthew P
aDepartment of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA bHealth Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa cDepartment of Epidemiology, Boston University School of Public Health dDepartment of Pediatrics, Boston University School of Medicine, Boston, Massachusetts, USA.
AIDS. 2016 Sep 24;30(15):2351-60. doi: 10.1097/QAD.0000000000001211.
Conduct a meta-analysis examining differential all-cause mortality rates between HIV-exposed uninfected (HEU) infants and children as compared with their HIV-unexposed uninfected (HUU) counterparts.
Meta-analysis summarizing the difference in mortality between HEU and HUU infants and children. Reviewed studies comparing children in the two groups for all-cause mortality, in any setting, from 1994 to 2016 from six databases.
Meta-analyses were done estimating overall mortality comparing the two groups, stratified by duration of follow-up time from birth (0-12, 12-24 and >24 months) and by year enrollment ended in each study: less than 2002 compared with at least 2002, when single-dose nevirapine for prevention of mother-to-child transmission (PMTCT) commenced in low-income and middle-income countries.
Included 22 studies, for a total of 29 212 study participants [n = 8840 (30.3%) HEU; n = 20 372 (37.7%) HUU]. Random effects models showed HEU had a more than 70% increased risk of mortality vs. HUU. Stratifying by age showed that HEU vs. HUU had a significant 60-70% increased risk of death at every age strata. There was a significant 70% increase in the risk of mortality between groups before the implementation of PMTCT, which remained after 2002 [risk ratio: 1.46; 95% confidence interval (CI): 1.14-1.87], when the availability of PMTCT services was widespread, suggesting that prenatal antiretroviral therapy, and healthier mothers, does not fully eliminate this increased risk in mortality.
We show a consistent increase risk of mortality for HEU vs. HUU infants and children. Longitudinal research is needed to elucidate underlying mechanisms, such as maternal and infant health status and breast feeding practices, which may help explain these differences in mortality.
进行一项荟萃分析，比较暴露于HIV但未感染（HEU）的婴幼儿与未暴露于HIV且未感染（HUU）的婴幼儿之间的全因死亡率差异。
荟萃分析，总结HEU和HUU婴幼儿的死亡率差异。回顾了1994年至2016年期间从六个数据库中获取的、在任何环境下比较两组儿童全因死亡率的研究。
进行荟萃分析，估计两组的总体死亡率，并按出生后的随访时间（0 - 12个月、12 - 24个月和>24个月）以及每项研究的入组结束年份进行分层：与至少2002年（低收入和中等收入国家开始采用单剂量奈韦拉平预防母婴传播[PMTCT]之时）相比，2002年之前。
纳入22项研究，共有29212名研究参与者[n = 8840（30.3%）为HEU；n = 20372（37.7%）为HUU]。随机效应模型显示，与HUU相比，HEU的死亡风险增加了70%以上。按年龄分层显示，在每个年龄层，HEU与HUU相比，死亡风险显著增加60 - 70%。在实施PMTCT之前，两组之间的死亡风险显著增加70%，在2002年之后这一情况仍然存在[风险比：1.46；95%置信区间（CI）：1.14 - 1.87]，此时PMTCT服务已广泛普及，这表明产前抗逆转录病毒疗法以及母亲更健康，并不能完全消除这种增加的死亡风险。
我们发现，与HUU婴幼儿相比，HEU婴幼儿的死亡风险持续增加。需要进行纵向研究以阐明潜在机制，如母婴健康状况和母乳喂养方式，这可能有助于解释这些死亡率差异。
