White Marina, Feucht Ute D, Duffley Eleanor, Molokoane Felicia, Durandt Chrisna, Cassol Edana, Rossouw Theresa, Connor Kristin L
Department of Health Sciences, Carleton University, Ottawa, ON, K1S 5B6, Canada.
Paediatrics, University of Pretoria, Pretoria, GP 0002, South Africa.
Pilot Feasibility Stud. 2020 Dec 11;6(1):192. doi: 10.1186/s40814-020-00725-8.
As mother-to-child transmission of HIV decreases, and the population of infants who are born HIV-exposed, but uninfected (HEU) continues to rise, there is a growing need to understand the development and health outcomes of infants who are HEU to ensure that they have the healthiest start to life.
In a prospective cohort pilot study at Kalafong Hospital, Pretoria, South Africa, we aimed to determine if we could recruit new mothers living with HIV on antiretrovirals (ART; n = 20) and not on ART (n = 20) and new mothers without HIV (n = 20) through our clinics to study the effects of HEU on growth and immune- and neurodevelopment in infants in early life, and test the hypothesis that infants who were HEU would have poorer health outcomes compared to infants who were HIV-unexposed, uninfected (HUU). We also undertook exploratory analyses to investigate relationships between the early nutritional environment, food insecurity and infant development. Infant growth, neurodevelopment (Guide for Monitoring Child Development [GMCD]) and levels of monocyte subsets (CD14, CD16 and CCR2 expression [flow cytometry]) were measured in infants at birth and 12 weeks (range 8-16 weeks).
We recruited 33 women living with HIV on ART and 22 women living without HIV within 4 days of delivery from June to December 2016. Twenty-one women living with HIV and 10 without HIV returned for a follow-up appointment at 12 weeks postpartum. The high mobility of this population presented major challenges to participant retention. Preliminary analyses revealed lower head circumference and elevated CCR2+ (% and median fluorescence intensity) on monocytes at birth among infants who were HEU compared to HUU. Maternal reports of food insecurity were associated with lower maternal nutrient intakes at 12 weeks postpartum and increased risk of stunting at birth for infants who were HEU, but not infants who were HUU.
Our small feasibility pilot study suggests that HEU may adversely affect infant development, and further, infants who are HEU may be even more vulnerable to the programming effects of suboptimal nutrition in utero and postnatally. This pilot and preliminary analyses have been used to inform our research questions and protocol in our ongoing, full-scale study.
随着艾滋病病毒母婴传播率的下降，出生时暴露于艾滋病病毒但未感染（HEU）的婴儿数量持续上升，因此越来越有必要了解HEU婴儿的发育情况和健康结局，以确保他们拥有最健康的人生开端。
在南非比勒陀利亚卡拉方医院进行的一项前瞻性队列试点研究中，我们旨在确定能否通过我们的诊所招募正在接受抗逆转录病毒治疗（ART；n = 20）和未接受ART治疗（n = 20）的感染艾滋病病毒的新妈妈以及未感染艾滋病病毒的新妈妈（n = 20），以研究HEU对婴儿早期生长、免疫和神经发育的影响，并检验以下假设：与未暴露于艾滋病病毒且未感染（HUU）的婴儿相比，HEU婴儿的健康结局更差。我们还进行了探索性分析，以研究早期营养环境、粮食不安全与婴儿发育之间的关系。在婴儿出生时和12周（8 - 16周）时测量其生长情况、神经发育（儿童发育监测指南[GMCD]）和单核细胞亚群水平（CD14、CD16和CCR2表达[流式细胞术]）。
在2016年6月至12月分娩后的4天内，我们招募了33名正在接受ART治疗的感染艾滋病病毒的女性和22名未感染艾滋病病毒的女性。21名感染艾滋病病毒的女性和10名未感染艾滋病病毒的女性在产后12周返回进行随访。该人群的高流动性给参与者的保留带来了重大挑战。初步分析显示，与HUU婴儿相比，HEU婴儿出生时头围较小，单核细胞上CCR2 +（%和中位荧光强度）升高。粮食不安全的母亲报告与产后12周时母亲营养摄入量较低以及HEU婴儿出生时发育迟缓风险增加有关，但与HUU婴儿无关。
我们这项小规模的可行性试点研究表明，HEU可能会对婴儿发育产生不利影响，此外，HEU婴儿可能更容易受到子宫内和出生后营养欠佳的编程效应的影响。这项试点研究和初步分析已用于为我们正在进行的全面研究中的研究问题和方案提供信息。
