HIV 暴露和未暴露的早产儿、极低出生体重儿的短期结局：一项纵向、基于医院的研究。
Short-term outcomes of HIV-exposed and HIV-unexposed preterm, very low birthweight neonates: a longitudinal, hospital-based study.
机构信息
Department of Neonatology, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa.
Department of Paediatrics & Child Health, Red Cross War Memorial Children's Hospital & University of Cape Town, Cape Town, South Africa.
出版信息
J Perinatol. 2020 Mar;40(3):445-455. doi: 10.1038/s41372-019-0541-4. Epub 2019 Oct 31.
OBJECTIVE
To compare short-term outcomes of very low birthweight (VBLW, <1500 g) neonates by maternal HIV status.
DESIGN
Retrospective hospital-based cohort in Cape Town, South Africa.
RESULTS
Of 1579 mothers, 316 (20%) were HIV-positive; 183/316 (58%) received ≥8 weeks of antenatal antiretrovirals. HIV-exposed neonates (HIVE, vs HIV-unexposed, HIVU) had increased risk of necrotising enterocolitis (NEC; OR 1.93, 95% CI 1.27-2.92) and invasive ventilation (OR 1.35, 95% CI 1.01-1.79). Extremely low birthweight (ELBW, <1000 g) modified the HIV-exposure-mortality relationship: among ELBW neonates, HIVE vs HIVU mortality OR 1.75 (95% CI 1.13-2.69); among non-ELBW, OR 0.89 (95% CI 0.54-1.49). Antiretrovirals (≥8 vs <8 weeks/none) reduced NEC (OR 0.46, 95% CI 0.22-0.97) and invasive ventilation risks (OR 0.57, 95% CI 0.32-0.99). HIV-PCR results were available for 228/316 (72%) HIVE neonates; 11/228 (5%) tested positive.
CONCLUSIONS
Among VLBW neonates, HIV-exposure was associated with increased risk of adverse short-term outcomes; antenatal antiretrovirals were protective.
目的
比较 HIV 阳性和阴性极低出生体重儿（VLBW，<1500 克）的短期结局。
方法
这是南非开普敦的一项基于医院的回顾性队列研究。
结果
在 1579 名母亲中，316 名（20%）HIV 阳性；183/316（58%）接受了≥8 周的产前抗逆转录病毒治疗。HIV 暴露儿（HIVE，与 HIV 未暴露儿，HIVU）发生坏死性小肠结肠炎（NEC；OR 1.93，95%CI 1.27-2.92）和有创通气（OR 1.35，95%CI 1.01-1.79）的风险增加。极低出生体重儿（ELBW，<1000 克）改变了 HIV 暴露与死亡率的关系：在 ELBW 新生儿中，HIVE 与 HIVU 的死亡率比值为 1.75（95%CI 1.13-2.69）；而非 ELBW 新生儿的比值为 0.89（95%CI 0.54-1.49）。抗逆转录病毒治疗（≥8 周/＜8 周/无）降低了 NEC（OR 0.46，95%CI 0.22-0.97）和有创通气的风险（OR 0.57，95%CI 0.32-0.99）。228/316（72%）名 HIVE 新生儿有 HIV-PCR 结果；11/228（5%）结果阳性。
结论
在 VLBW 新生儿中，HIV 暴露与不良短期结局的风险增加相关；产前抗逆转录病毒治疗具有保护作用。
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