南非开普敦和赞比亚卢萨卡宫内 HIV 和 ARV 暴露婴儿的生长模式。
Growth patterns of infants with in- utero HIV and ARV exposure in Cape Town, South Africa and Lusaka, Zambia.
机构信息
Division of Epidemiology & Biostatistics, Faculty of Health Sciences, School of Public Health and Family Medicine, University of Cape Town, Anzio Road, Observatory, Cape Town, 7925, South Africa.
Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
出版信息
BMC Public Health. 2022 Jan 10;22(1):55. doi: 10.1186/s12889-021-12476-z.
BACKGROUND
Infants born HIV-exposed yet remain uninfected (HEU) are at increased risk of poorer growth and health compared to infants born HIV-unexposed (HU). Whether maternal antiretroviral treatment (ART) in pregnancy ameliorates this risk of poorer growth is not well understood. Furthermore, whether risks are similar across high burden HIV settings has not been extensively explored.
METHODS
We harmonized data from two prospective observational studies conducted in Cape Town, South Africa, and Lusaka, Zambia, to compare weight-for-age (WAZ), length-for-age (LAZ) and weight-for-length (WLZ) Z-scores between infants who were HEU and HU, converting infant anthropometric measures using World Health Organisation Growth Standards adjusted for age and sex. Linear mixed effects models were fit to identify risk factors for differences in anthropometrics at 6-10 weeks and 6 months by infant HIV exposures status and by timing of exposure to maternal ART, either from conception or later in gestation.
RESULTS
Overall 773 mother-infant pairs were included across two countries: women living with HIV (WLHIV), 51% (n = 395) with 65% on ART at conception and 35% initiating treatment in pregnancy. In linear mixed effects models, WAZ and WLZ at 6-10 weeks were lower among infants who were HEU vs HU [β = - 0.29 (95% CI: - 0.46, - 0.12) and [β = - 0.42 (95% CI: - 0.68, - 0.16)] respectively after adjusting for maternal characteristics and infant feeding with a random intercept for country. At 6 months, LAZ was lower [β = - 0.28 CI: - 0.50, - 0.06)] among infants who were HEU, adjusting for the same variables, with no differences in WAZ and WLZ. Within cohort evaluations identified different results with higher LAZ among infants who were HEU from Zambia at 6-10 weeks, [β = + 0.34 CI: + 0.01, + 0.68)] and lower LAZ among infants who were HEU from South Africa [β = - 0.30 CI: - 0.59, - 0.01)] at 6 months, without other anthropometric differences at either site.
CONCLUSION
Infant growth trajectories differed by country, highlighting the importance of studying contextual influences on outcomes of infants who were HEU.
背景
与未暴露于 HIV 的婴儿（HU）相比，HIV 暴露但未感染的婴儿（HEU）的生长和健康状况较差。尚不清楚母亲在怀孕期间接受抗逆转录病毒治疗（ART）是否可以改善这种较差的生长风险。此外，在高负担 HIV 环境中，风险是否相似尚未得到广泛探讨。
方法
我们协调了在南非开普敦和赞比亚卢萨卡进行的两项前瞻性观察性研究的数据，比较了 HEU 和 HU 婴儿的体重与年龄比值（WAZ）、长度与年龄比值（LAZ）和体重与长度比值（WLZ）Z 分数，使用世界卫生组织生长标准调整年龄和性别后，转换婴儿的人体测量值。线性混合效应模型用于根据婴儿 HIV 暴露状态和母体 ART 暴露时间（从受孕开始或妊娠后期）识别 6-10 周和 6 个月时人体测量差异的危险因素。
结果
总体而言，来自两个国家的 773 对母婴对被纳入研究：51%（n=395）的女性为 HIV 感染者（WLHIV），65%的人在受孕时接受 ART 治疗，35%的人在妊娠期间开始治疗。在调整了母体特征和婴儿喂养方式后，在 6-10 周时，HEU 婴儿的 WAZ 和 WLZ 低于 HU 婴儿[β=-0.29（95%CI：-0.46，-0.12）和β=-0.42（95%CI：-0.68，-0.16）]，并且对于国家有随机截距。在 6 个月时，LAZ 较低[β=-0.28（95%CI：-0.50，-0.06）]，在调整相同变量后，WAZ 和 WLZ 没有差异。队列内评估发现，在 6-10 周时，来自赞比亚的 HEU 婴儿的 LAZ 较高[β=+0.34（95%CI：+0.01，+0.68）]，而来自南非的 HEU 婴儿的 LAZ 较低[β=-0.30（95%CI：-0.59，-0.01）]，在两个地点均无其他人体测量差异。
结论
婴儿的生长轨迹因国家而异，突出了研究 HIV 暴露但未感染婴儿的背景影响对结果的重要性。
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