Weinberg Adriana, Mussi-Pinhata Marisa M, Yu Qilu, Cohen Rachel A, Almeida Volia C, Amaral Fabiana R, Freimanis Laura, Harris Donald Robert, Smith Christiana, Siberry George
1 Departments of Pediatrics, Medicine and Pathology, Anschutz Medical Center, University of Colorado Denver , Aurora, Colorado.
2 Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo , São Paulo, Brazil .
AIDS Res Hum Retroviruses. 2018 Jun;34(6):527-535. doi: 10.1089/AID.2017.0245. Epub 2018 Apr 23.
To identify factors that predispose human immunodeficiency virus (HIV)-exposed uninfected infants (HEUs) to higher incidence of severe infections, hospitalization, and death in the first 6-24 months of life compared with HEUs with and without lower respiratory tract infection (LRTI) in the first 6 months of life. Nested case-control study of 107 LRTI+ infants enrolled in the International Site Development Initiative (NISDI) Perinatal and Longitudinal Study in Latin American Countries (LILAC) studies with and 140 LRTI- in the first 6 months, matched by date and place of birth. Infants and mothers had plasma antibodies measured against respiratory syncytial virus (RSV), parainfluenza (PIV) 1, 2, 3, influenza, and pneumococcus 1, 5, 6B, and 14. Compared with LRTI-, mothers of LRTI+ HEUs had lower years of education, lower CD4 cells, and higher HIV plasma viral load at delivery, but similar use of antiretrovirals and cotrimoxazole and other sociodemographic characteristics. LRTI+ and LRTI- HEUs had similar demographic and hematological characteristics and antibody concentrations against respiratory pathogens at birth. At 6 months, the rates of seroconversions to respiratory pathogens and antibody responses to tetanus vaccine were also similar. However, antibody concentrations to RSV were significantly higher in LRTI+ compared with LRTI- HEUs and marginally higher to PIV1. Maternal factors associated with advanced HIV disease, but unrelated to the use of antiretrovirals, cotrimoxazole, or the level of maternal antibodies against respiratory pathogens, contribute to the increased risk of LRTI in HEUs. In HEUs, antiretroviral and cotrimoxazole use, exposure to respiratory pathogens and humoral immune responses were not associated with the incidence of LRTI.
为了确定与出生后6 - 24个月内严重感染、住院和死亡发生率较高相关的因素，这些因素使暴露于人类免疫缺陷病毒（HIV）但未感染的婴儿（HEU）相较于出生后6个月内有或无下呼吸道感染（LRTI）的HEU更易出现上述情况。对107名参加拉丁美洲国家围产期和纵向研究（LILAC）的国际站点发展倡议（NISDI）研究中的LRTI +婴儿以及140名出生后6个月内未发生LRTI的婴儿进行巢式病例对照研究，按照出生日期和地点进行匹配。对婴儿和母亲检测了针对呼吸道合胞病毒（RSV）、副流感病毒（PIV）1、2、3、流感病毒以及肺炎球菌1、5、6B和14的血浆抗体。与未发生LRTI的HEU母亲相比，发生LRTI的HEU母亲受教育年限较短、分娩时CD4细胞较低且HIV血浆病毒载量较高，但抗逆转录病毒药物和复方新诺明的使用情况以及其他社会人口学特征相似。发生LRTI和未发生LRTI的HEU在出生时的人口统计学和血液学特征以及针对呼吸道病原体的抗体浓度相似。在6个月时，对呼吸道病原体的血清转化速率和对破伤风疫苗的抗体反应也相似。然而，与未发生LRTI的HEU相比，发生LRTI的HEU中针对RSV的抗体浓度显著更高，针对PIV1的抗体浓度略高。与晚期HIV疾病相关但与抗逆转录病毒药物、复方新诺明的使用或母亲针对呼吸道病原体的抗体水平无关的母亲因素，会增加HEU发生LRTI的风险。在HEU中，抗逆转录病毒药物和复方新诺明的使用、接触呼吸道病原体和体液免疫反应与LRTI的发生率无关。
