Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine.
Department of Paediatrics & Child Health, University of Cape Town.
AIDS. 2018 Aug 24;32(13):1781-1791. doi: 10.1097/QAD.0000000000001872.
To assess neurodevelopment of breastfed HIV-exposed uninfected (HEU) and breastfed HIV-unexposed children in the context of universal maternal antiretroviral therapy (ART).
Prospective study with antenatal enrolment and follow-up of breastfeeding HEU and HIV-unexposed mother-infant pairs through 12-18 months postpartum.
Peri-urban community, Cape Town, South Africa.
HEU (n = 215) and HIV-unexposed (n = 306) children.
Cognitive, motor and language development at median 13 (interquartile range 12-14) months of age: continuous and dichotomous Bayley Scales of Infant and Toddler Development Third Edition (delay defined as composite score <85).
Incidence of preterm delivery (<37 weeks) was similar among HEU and HIV-unexposed children (11 vs. 9%, P = 0.31; median gestation 39 weeks); 48% were boys. Median breastfeeding duration was shorter among HEU vs. HIV-unexposed children (6 vs. 10 months). All HIV-infected mothers initiated lifelong ART (tenofovir-emtricitabine-efavirenz) antenatally. HEU (vs. HIV-unexposed) children had higher odds of cognitive delay [odds ratio (OR) 2.28 (95% confidence interval (CI) 1.13-4.60)] and motor delay [OR 2.10 (95% CI 1.03-4.28)], but not language delay, in crude and adjusted analysis. Preterm delivery modified this relationship for motor development: compared with term HIV-unexposed children, term HEU children had similar odds of delay, preterm HIV-unexposed children had five-fold increased odds of delay (adjusted OR 4.73, 95% CI 1.32; 16.91) and preterm HEU children, 16-fold increased odds of delay (adjusted OR 16.35, 95% CI 5.19; 51.54).
Young HEU children may be at increased risk for cognitive and motor delay despite universal maternal ART and breastfeeding; those born preterm may be particularly vulnerable.
在普遍使用母婴抗逆转录病毒疗法（ART）的情况下，评估母乳喂养的艾滋病毒暴露但未感染（HEU）和未暴露于 HIV 的婴儿的神经发育情况。
前瞻性研究，在产前招募并随访母乳喂养的 HEU 和未感染 HIV 的母婴对，直至产后 12-18 个月。
南非开普敦城乡社区。
HEU（n=215）和未感染 HIV（n=306）儿童。
中位数为 13 个月（四分位间距 12-14 个月）时的认知、运动和语言发育：连续和二分贝利婴幼儿发育量表第三版（延迟定义为综合评分<85）。
HEU 和未感染 HIV 的婴儿早产（<37 周）的发生率相似（11%比 9%，P=0.31；中位孕龄 39 周）；48%为男孩。HEU 婴儿的中位母乳喂养时间短于未感染 HIV 的婴儿（6 比 10 个月）。所有感染 HIV 的母亲均在产前开始接受终生 ART（替诺福韦-恩曲他滨-依非韦伦）。与未感染 HIV 的婴儿相比，HEU 婴儿的认知延迟（优势比 2.28（95%置信区间 1.13-4.60））和运动延迟（优势比 2.10（95%置信区间 1.03-4.28））的可能性更高，但语言延迟没有差异，无论是在粗分析还是调整分析中。早产改变了这种与运动发育的关系：与足月未感染 HIV 的婴儿相比，足月 HEU 婴儿延迟的可能性相似，早产未感染 HIV 的婴儿延迟的可能性增加五倍（调整后的优势比 4.73，95%置信区间 1.32；16.91），而早产 HEU 婴儿延迟的可能性增加 16 倍（调整后的优势比 16.35，95%置信区间 5.19；51.54）。
尽管普遍使用母婴抗逆转录病毒疗法和母乳喂养，年轻的 HEU 婴儿仍可能面临认知和运动发育延迟的风险增加；那些早产儿可能尤其脆弱。
