Botswana-UPenn Partnership, Gaborone, Botswana.
Division of Pediatric Infectious Diseases, Duke University Medical Center, Durham, North Carolina.
J Pediatric Infect Dis Soc. 2019 Mar 28;8(1):13-20. doi: 10.1093/jpids/pix092.
Human immunodeficiency virus-exposed but uninfected (HIV-EU) children have a higher mortality rate than the children of HIV-negative mothers (HIV-unexposed). Causal mediators of the poor health outcomes of HIV-EU children remain poorly defined.
We conducted a hospital-based prospective cohort study of children aged 1 to 23 months with clinically defined pneumonia. The children were recruited at a referral hospital in Gaborone, Botswana, between April 2012 and June 2016. The primary outcome, treatment failure at 48 hours, was assessed by an investigator blinded to the children's HIV-exposure status. We examined associations between HIV exposure and pneumonia outcomes in HIV-uninfected children. We next determined whether the effect of HIV exposure on outcomes was mediated by low-birth-weight status, nonbreastfeeding, malnutrition, in utero exposure to combination antiretroviral therapy, or pneumonia severity.
A total of 352 HIV-uninfected children were included in these analyses, including 245 (70%) HIV-unexposed and 107 (30%) HIV-EU children. Their median age was 7.4 months, and 57% were male. Treatment failure occurred in 111 (32%) children, and 19 (5.4%) children died. HIV-EU children were more likely to fail treatment (risk ratio [RR], 1.57 [95% confidence interval (CI), 1.19-2.07]; P = .002) and had a higher in-hospital mortality rate (RR, 4.50 [95% CI, 1.86-10.85]; P = .001) than HIV-unexposed children. Nonbreastfeeding mediated 47% of the effect of HIV exposure on the risk of in-hospital death.
HIV-EU children have worse pneumonia outcomes than HIV-unexposed children. Nonbreastfeeding mediates nearly half of the effect of HIV exposure on pneumonia mortality. Our findings provide additional evidence for a mortality benefit of breastfeeding by HIV-EU children.
与 HIV 阴性母亲所生的子女（HIV 未暴露）相比，人类免疫缺陷病毒暴露但未感染（HIV-EU）的儿童死亡率更高。HIV-EU 儿童健康结果不良的因果中介因素仍未得到很好的定义。
我们对 2012 年 4 月至 2016 年 6 月在博茨瓦纳哈博罗内的一家转诊医院招募的 1 至 23 个月龄有临床定义肺炎的儿童进行了一项基于医院的前瞻性队列研究。主要结局是 48 小时时治疗失败，由一名对儿童 HIV 暴露状况不知情的研究者评估。我们检查了 HIV 暴露与 HIV 未感染儿童肺炎结局之间的关联。接下来，我们确定 HIV 暴露对结局的影响是否通过低出生体重、非母乳喂养、营养不良、宫内接触联合抗逆转录病毒治疗或肺炎严重程度来介导。
共有 352 名 HIV 未感染儿童纳入了这些分析，包括 245 名（70%）HIV 未暴露和 107 名（30%）HIV-EU 儿童。他们的中位年龄为 7.4 个月，57%为男性。111 名（32%）儿童治疗失败，19 名（5.4%）儿童死亡。与 HIV 未暴露儿童相比，HIV-EU 儿童更有可能治疗失败（风险比[RR]，1.57 [95%置信区间[CI]，1.19-2.07]；P=.002），院内死亡率更高（RR，4.50 [95% CI，1.86-10.85]；P=.001）。非母乳喂养解释了 HIV 暴露对院内死亡风险的影响的 47%。
与 HIV 未暴露儿童相比，HIV-EU 儿童的肺炎结局更差。非母乳喂养解释了 HIV 暴露对肺炎死亡率影响的近一半。我们的研究结果提供了更多证据表明，HIV-EU 儿童母乳喂养具有生存获益。
