Division of Epidemiology & Biostatistics, School of Public Health, University of Cape Town, Cape Town, South Africa.
Mailman School of Public Health, ICAP at Columbia University, Columbia University, New York, New York, USA.
J Int AIDS Soc. 2023 Oct;26 Suppl 4(Suppl 4):e26152. doi: 10.1002/jia2.26152.
Several HIV-related syndemics have been described among adults. We investigated syndemic vulnerability to hazardous drinking (HD), intimate partner violence (IPV) and household food insecurity (HFIS) in breastfed children born without HIV in urban South Africa. We compared those who were perinatally HIV exposed (CHEU) to those who were not (CHU), under conditions of universal maternal antiretroviral therapy (ART) and breastfeeding.
A prospective cohort of pregnant women living with HIV (WLHIV), and without HIV, were enrolled and followed with their infants for 12 months postpartum (2013-2017). All WLHIV initiated antenatal efavirenz-based ART. Measurements of growth (∼3 monthly), infectious cause hospitalisation, ambulatory childhood illness (2-week recall) and neurodevelopment (BSID-III, measured at ∼12 months' age) were compared across bio-social strata using generalised linear regression models, with interaction terms; maternal data included interview-based measures for HD (AUDIT-C), IPV (WHO VAW) and HFIS.
Among 872 breastfeeding mother-infant pairs (n = 461 CHEU, n = 411 CHU), WLHIV (vs. HIV negative) reported more unemployment (279/461, 60% vs. 217/411, 53%; p = 0.02), incomplete secondary education (347/461, 75% vs. 227/411, 55%; p < 0.0001), HD (25%, 117/459 vs. 7%, 30/411; p < 0.0001) and IPV (22%, 101/457 vs. 8%, 32/411; p < 0.0001) at enrolment; and HFIS at 12 months (45%, 172/386 vs. 30%, 105/352; p > 0.0001). There were positive interactions between maternal HIV and other characteristics. Compared to food secure CHU, the mean difference (95% CI) in weight-for-age Z-score (WAZ) was 0.06 (-0.14; 0.25) for food insecure CHU; -0.26 (-0.42; -0.10) for food secure CHEU; and -0.43 (-0.61; -0.25), for food insecure CHEU. Results were similar for underweight (WAZ < -2), infectious-cause hospitalisation, cognitive and motor delay. HIV-IPV interactions were evident for ambulatory diarrhoea and motor delay. There were HIV-HD interactions for odds of underweight, stunting, cognitive and motor delay. Compared to HD-unexposed CHU, the odds ratios (95% CI) of underweight were 2.31 (1.11; 4.82) for HD-exposed CHU; 3.57 (0.84; 15.13) for HD-unexposed CHEU and 6.01 (2.22; 16.22) for HD-exposed CHEU.
These data suggest that maternal HIV-related syndemics may partly drive excess CHEU health risks, highlighting an urgent need for holistic maternal and family care and support alongside ART to optimise the health of CHEU.
已经描述了几种与艾滋病毒相关的综合征在成年人中存在。我们调查了在南非城市中，母乳喂养的未感染艾滋病毒的婴儿中，与危险饮酒（HD）、亲密伴侣暴力（IPV）和家庭粮食不安全（HFIS）相关的综合征易感性。我们比较了那些围产期感染艾滋病毒的婴儿（CHEU）和未感染的婴儿（CHU），在普遍使用抗逆转录病毒疗法（ART）和母乳喂养的情况下。
前瞻性队列研究招募了艾滋病毒阳性（WLHIV）和艾滋病毒阴性的孕妇，并对其婴儿进行了 12 个月的产后随访（2013-2017 年）。所有 WLHIV 均在产前接受了基于依非韦伦的 ART。使用广义线性回归模型，通过交互项，比较了不同生物社会分层下的生长情况（约每 3 个月一次）、传染性病因住院、儿童日常疾病（2 周回顾）和神经发育（BSID-III，约在 12 个月时测量）。母亲的数据包括基于访谈的 HD（AUDIT-C）、IPV（WHO VAW）和 HFIS 测量值。
在 872 名母乳喂养的母婴对中（n = 461 CHEU，n = 411 CHU），WLHIV（与 HIV 阴性相比）报告了更多的失业（279/461，60%比 217/411，53%；p = 0.02）、未完成中等教育（347/461，75%比 227/411，55%；p < 0.0001）、HD（25%，117/459 比 7%，30/411；p < 0.0001）和 IPV（22%，101/457 比 8%，32/411；p < 0.0001）在入组时；12 个月时 HFIS 为 45%（172/386）比 30%（105/352）（p > 0.0001）。母亲 HIV 与其他特征之间存在正交互作用。与粮食安全的 CHU 相比，粮食不安全的 CHEU 的体重-年龄 Z 评分（WAZ）均值差（95%CI）为 0.06（-0.14；0.25）；粮食安全的 CHEU 为-0.26（-0.42；-0.10）；粮食不安全的 CHEU 为-0.43（-0.61；-0.25）。体重不足（WAZ < -2）、传染性病因住院、认知和运动延迟的结果相似。HIV-IPV 交互作用在门诊腹泻和运动延迟方面明显。HIV-HD 交互作用对体重不足、发育迟缓、认知和运动延迟的发生几率有影响。与 HD 未暴露的 CHU 相比，HD 暴露的 CHEU 的体重不足发生率比值比（95%CI）为 2.31（1.11；4.82）；HD 未暴露的 CHEU 为 3.57（0.84；15.13）；HD 暴露的 CHEU 为 6.01（2.22；16.22）。
这些数据表明，母亲的艾滋病毒相关综合征可能部分导致了 CHEU 健康风险的增加，突出了迫切需要全面的母婴和家庭护理和支持，以及抗逆转录病毒治疗，以优化 CHEU 的健康状况。
