HIV 病毒血症与普遍抗逆转录病毒治疗和母乳喂养背景下 HIV 暴露未感染儿童的神经发育：一项前瞻性研究。
HIV Viremia During Pregnancy and Neurodevelopment of HIV-Exposed Uninfected Children in the Context of Universal Antiretroviral Therapy and Breastfeeding: A Prospective Study.
机构信息
From the Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine.
Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa.
出版信息
Pediatr Infect Dis J. 2019 Jan;38(1):70-75. doi: 10.1097/INF.0000000000002193.
BACKGROUND
Elevated HIV viral load (VL) in pregnancy has been linked to increased risk of mortality, immunologic abnormalities, infectious morbidity and restricted growth among HIV-exposed uninfected (HEU) children, but little is known about effects on child development.
METHODS
HIV-infected women initiating lifelong antiretroviral therapy (ART; tenofovir + emtricitabine + efavirenz) antenatally were followed from first antenatal visit through delivery and with their breastfed infants postpartum. Cognitive, motor and expressive language development (Bayley Scales of Infant and Toddler Development-Third Edition; delay defined as score <85) were assessed on a subset of HEU infants. HIV VL was measured at ART initiation, in third trimester and around delivery. Cumulative viremia in pregnancy was expressed as log10 VL copies × year/mL [viremia copy-years (VCY)]. Relationships between VCY and development were examined after adjusting for socioeconomic, behavioral and psychosocial confounders.
RESULTS
Women (median pre-ART log10 VL 4.1, CD4 349 cells/mm) commonly reported adverse social circumstances (44% informal housing, 63% unemployed, 29% risky drinking). Among 214 infants (median age, 13 months; 53% male; 13% born <37 weeks' gestation), viremia predicted lower motor and expressive language, but not cognitive, scores in crude and adjusted analysis [per log10 VCY increase, αβ (95% confidence interval [CI]): motor, -2.94 (-5.77 to -0.11); language, -3.71 (-6.73 to -0.69) and cognitive -2.19 (-5.02 to 0.65)]. Increasing VCY also predicted higher relative odds of motor delay [adjusted odds ratio (aOR): 3.32; 95% CI: 1.36-8.14) and expressive language delay (aOR: 2.79; 95% CI: 1.57-4.94), but not cognitive delay (aOR: 1.68; 95% CI: 0.84-3.34).
CONCLUSIONS
Cumulative maternal HIV viremia in pregnancy may have adverse implications for HEU child development.
背景
妊娠期间 HIV 病毒载量（VL）升高与 HIV 暴露但未感染（HEU）儿童的死亡率增加、免疫异常、传染性发病率和生长受限有关，但对儿童发育的影响知之甚少。
方法
在产前开始接受终身抗逆转录病毒治疗（ART；替诺福韦+恩曲他滨+依非韦伦）的 HIV 感染妇女，从第一次产前就诊到分娩以及产后母乳喂养婴儿时进行随访。在一组 HEU 婴儿中评估认知、运动和表达语言发育（Bayley 婴儿和幼儿发育量表第三版；定义为得分<85 的延迟）。在 ART 开始时、第三孕期和分娩前后测量 HIV VL。妊娠期间的累积病毒血症表示为 log10 VL 拷贝×年/mL[病毒载量拷贝年（VCY）]。在调整了社会经济、行为和心理社会混杂因素后，检查了 VCY 与发育之间的关系。
结果
女性（中位 ART 前 log10 VL 4.1，CD4 349 个细胞/mm）普遍报告社会环境不利（44%居住在非正式住房中，63%失业，29%饮酒风险高）。在 214 名婴儿中（中位年龄 13 个月；53%为男性；13%出生时<37 周），病毒血症预测了较低的运动和表达语言评分，但在粗分析和调整分析中均未预测认知评分[每增加 log10 VCY，αβ（95%置信区间[CI]）：运动，-2.94（-5.77 至-0.11）；语言，-3.71（-6.73 至-0.69）和认知，-2.19（-5.02 至 0.65）]。增加 VCY 也预示着运动延迟的相对优势比（调整后的优势比[aOR]：3.32；95%CI：1.36-8.14）和表达语言延迟（aOR：2.79；95%CI：1.57-4.94），但对认知延迟（aOR：1.68；95%CI：0.84-3.34）无影响。
结论
妊娠期间母体 HIV 病毒血症的累积可能对 HEU 儿童的发育产生不良影响。
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