津巴布韦全国代表性母婴队列中 HIV 暴露但未感染婴儿的发病率和死亡率。
HIV-exposed uninfected infant morbidity and mortality within a nationally representative prospective cohort of mother-infant pairs in Zimbabwe.
机构信息
Division of Global HIV and TB, Center for Global Health, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
AIDS & TB Department, Ministry of Health & Child Care of Zimbabwe.
出版信息
AIDS. 2020 Jul 15;34(9):1339-1346. doi: 10.1097/QAD.0000000000002567.
OBJECTIVE
To examine morbidity and mortality risk among HIV-exposed uninfected (HEU) infants.
DESIGN
Secondary data analysis of HEU infants in a prospective cohort study of mother-infant pairs.
METHODS
Infants were recruited from immunization clinics (n = 151) in Zimbabwe from February to August 2013, enrolled at 4-12 weeks age, and followed every 3 months until incident HIV-infection, death, or 18-month follow-up. We estimated cumulative mortality probability and hazard ratios with 95% confidence intervals (CIs) using Kaplan-Meier curves and Cox regression, respectively. We also described reported reasons for infant hospitalization and symptoms preceding death. Median weight-for-age z-scores (WAZ) and median age were calculated and analyzed across study visits.
RESULTS
Of 1188 HIV-exposed infants, 73 (6.1%) contracted HIV; we analyzed the remaining 1115 HEU infants. In total, 54 (4.8%) infants died, with median time to death of 5.5 months since birth (interquartile range: 3.6-9.8 months). Diarrhea, difficulty breathing, not eating, fever, and cough were commonly reported (range: 7.4-22.2%) as symptoms preceding infant death. Low birth weight was associated with higher mortality (adjusted hazard ratio 2.66, CI: 1.35-5.25), whereas maternal antiretroviral therapy predelivery (adjusted hazard ratio 0.34, CI: 0.18-0.64) and exclusive breastfeeding (adjusted hazard ratio 0.50, CI: 0.28-0.91) were associated with lower mortality. Overall, 9.6% of infants were hospitalized. Infant median WAZ declined after 3 months of age, reaching a minimum at 14.5 months of age, at which 50% of infants were underweight (WAZ below -2.0).
CONCLUSION
Clinical interventions including maternal antiretroviral therapy; breastfeeding and infant feeding counseling and support; and early prevention, identification, and management of childhood illness; are needed to reduce HEU infant morbidity and mortality.
目的
研究 HIV 暴露但未感染（HEU）婴儿的发病率和死亡率风险。
设计
对母婴配对前瞻性队列研究中 HEU 婴儿的二次数据分析。
方法
2013 年 2 月至 8 月，从津巴布韦的免疫接种诊所（n=151）招募婴儿，在 4-12 周龄时入组，并每 3 个月随访一次，直至发生 HIV 感染、死亡或 18 个月随访。我们使用 Kaplan-Meier 曲线和 Cox 回归分别估计累积死亡率概率和风险比及其 95%置信区间（CI）。我们还描述了婴儿住院的报告原因和死亡前的症状。计算并分析了研究访视时的体重年龄 z 评分中位数（WAZ）和年龄中位数。
结果
在 1188 名 HIV 暴露的婴儿中，有 73 名（6.1%）感染了 HIV；我们分析了其余 1115 名 HEU 婴儿。共有 54 名（4.8%）婴儿死亡，自出生以来中位死亡时间为 5.5 个月（四分位距：3.6-9.8 个月）。腹泻、呼吸困难、不吃东西、发热和咳嗽是常见的死亡前症状（发生率为 7.4%-22.2%）。低出生体重与更高的死亡率相关（调整后的风险比 2.66，CI：1.35-5.25），而产妇产前抗逆转录病毒治疗（调整后的风险比 0.34，CI：0.18-0.64）和纯母乳喂养（调整后的风险比 0.50，CI：0.28-0.91）与较低的死亡率相关。总体而言，9.6%的婴儿住院。婴儿中位 WAZ 在 3 个月后下降，在 14.5 个月时达到最低值，此时 50%的婴儿体重不足（WAZ 低于-2.0）。
结论
需要采取临床干预措施，包括产妇抗逆转录病毒治疗；母乳喂养和婴儿喂养咨询和支持；以及早期预防、识别和管理儿童疾病，以降低 HEU 婴儿的发病率和死亡率。
Zotero 插件