评估 HIV 感染和抗逆转录病毒治疗对孕妇及其后代的心血琯代谢健康的影响（ARTMOMSBABES）。

Assessment of the impact of HIV infection and anti-retroviral treatment on the cardiometabolic health of pregnant mothers and their offspring (ARTMOMSBABES).

机构信息

Department of Biological and Environmental Sciences, Faculty of Natural Sciences, Walter Sisulu University PBX1, Mthatha, 5117, South Africa.

Department of Obstetrics and Gynaecology, Walter Sisulu University, Nelson Mandela Academic Hospital, Mthatha, 5117, South Africa.

出版信息

BMC Cardiovasc Disord. 2021 Jun 30;21(1):322. doi: 10.1186/s12872-021-02130-2.

DOI:10.1186/s12872-021-02130-2

PMID:34193034

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8247111/

Abstract

BACKGROUND

The risk of cardiovascular diseases (CVDs) is becoming more prevalent in pregnant women though not much data is available for pregnant women with human immunodeficiency virus (HIV). Foetoplacental vascular endothelial dysfunction is thought to be at the origin of chronic diseases such as diabetes and obesity later on in life. Because HIV and anti-retroviral treatment (ARTs) are associated with endothelial dysfunction, children exposed in utero to these conditions may be at greater risk of developing CVDs. Despite the high prevalence of HIV in pregnant South African women, little is known about the effects of ART on the cardiovascular health of the mother and offspring. Hence, the proposed study intends to investigate how HIV/ARTs may affect the cardiovascular health of the mother and offspring at different time points during the pregnancy and up to 2 years after birth.

METHODS

A longitudinal case-control study in HIV positive pregnant women on ART and HIV negative pregnant women will be conducted. All pregnant women will be assessed for cardio-metabolic risk factors and markers (lipids, anthropometric and glycaemic indies, oxidative stress), hemodynamic status (blood pressure parameters) and vascular function (arterial compliance, retinal microvasculature, uterine artery mean pulsatility index). Child health will be monitored in utero and postnatally via routine foetal health screening, placental integrity, anthropometry, blood pressure parameters, markers of oxidative stress and endothelial function in cord blood and cardiovascular epigenetic markers in urine.

DISCUSSION

There is a paucity of studies in South Africa and sub-Sahara Africa as a whole that utilised a longitudinal study model to assess the effects of ARTs on vascular endothelial changes in pregnant women living with HIV and the cardiometabolic health of their offspring. This study will therefore help to monitor changes in cardiometabolic risk during pregnancy and in children exposed in utero to HIV-infection and ART use. Findings from this study will provide useful information for developing guidelines on the use of ARTs in pregnancy and management of cardiometabolic health of the offspring of HIV positive mothers.

摘要

背景

尽管有关人类免疫缺陷病毒（HIV）感染孕妇的资料有限，但心血管疾病（CVD）的风险在孕妇中变得越来越普遍。胎儿胎盘血管内皮功能障碍被认为是导致日后糖尿病和肥胖等慢性疾病的根源。由于 HIV 和抗逆转录病毒治疗（ART）与内皮功能障碍有关，因此在子宫内暴露于这些条件下的儿童可能面临更大的 CVD 发病风险。尽管南非孕妇 HIV 感染率很高，但对于 ART 对母婴心血管健康的影响知之甚少。因此，拟议的研究旨在调查 HIV/ART 在妊娠不同时间点以及产后 2 年内如何影响母婴心血管健康。

方法

将对接受 ART 的 HIV 阳性孕妇和 HIV 阴性孕妇进行一项前瞻性病例对照研究。所有孕妇都将接受心血管代谢危险因素和标志物（血脂、人体测量和血糖指标、氧化应激）、血液动力学状态（血压参数）和血管功能（动脉顺应性、视网膜微血管、子宫动脉平均搏动指数）评估。通过常规胎儿健康筛查、胎盘完整性、人体测量、血压参数、脐带血氧化应激和内皮功能标志物以及尿液心血管表观遗传标志物，监测胎儿和产后儿童的健康状况。

讨论

在南非和整个撒哈拉以南非洲，利用纵向研究模型评估抗逆转录病毒治疗对 HIV 感染孕妇血管内皮变化和其子女代谢健康影响的研究很少。因此，这项研究将有助于监测妊娠期间和子宫内暴露于 HIV 感染和 ART 使用的儿童代谢风险的变化。这项研究的结果将为制定妊娠期抗逆转录病毒治疗使用指南和管理 HIV 阳性母亲子女代谢健康提供有用信息。