Department of Global Health, University of Washington, Seattle, Washington, USA.
Department of Epidemiology, University of Washington, Seattle, Washington, USA.
J Int AIDS Soc. 2023 Oct;26 Suppl 4(Suppl 4):e26149. doi: 10.1002/jia2.26149.
Predictors of neurodevelopment among children who are HIV-exposed uninfected (CHEU) are poorly understood.
Mothers with and without HIV and their children were enrolled during 6-week postnatal care visits across seven sites in Kenya between March 2021 and June 2022. Infant neurodevelopment was assessed using the Malawi Developmental Assessment Tool, including social, language, fine motor and gross motor domains. We used multivariate linear mixed effects models to identify associations between 1-year neurodevelopment scores, HIV and antiretroviral therapy (ART) exposures, and household factors, adjusted for potential confounders and clustered by the site.
At 1-year evaluation, CHEU (n = 709) and children who are HIV-unexposed uninfected (CHUU) (n = 715) had comparable median age (52 weeks) and sex distribution (49% vs. 52% female). Mothers living with HIV were older (31 vs. 27 years), had lower education (50% vs. 26% primary) and were more likely to be report moderate-to-severe food insecurity (26% vs. 9%) (p < 0.01 for all). Compared to CHUU, CHEU had higher language scores (adjusted coeff: 0.23, 95% CI: 0.06, 0.39) and comparable social, fine and gross motor scores. Among all children, preterm birth was associated with lower gross motor scores (adjusted coeff: -1.38, 95% CI: -2.05, -0.71), food insecurity was associated with lower social scores (adjusted coeff: -0.37, 95% CI: -0.73, -0.01) and maternal report of intimate partner violence (IPV) was associated with lower fine motor (adjusted coeff: -0.76, 95% CI: -1.40, -0.13) and gross motor scores (adjusted coeff: -1.07, 95% CI: -1.81, -0.33). Among CHEU, in utero efavirenz (EFV) exposure during pregnancy was associated with lower gross motor scores compared to dolutegravir (DTG) exposure (adjusted coeff: -0.51, 95% CI: -1.01, -0.03). Lower fine and gross motor scores were also associated with having a single or widowed mother (adjusted coeff: -0.45, 95% CI: -0.87, -0.03) or a deceased or absent father (adjusted coeff: -0.81, 95% CI: -1.58, -0.05), respectively.
Biologic and social factors were associated with child neurodevelopment. Despite socio-demographic differences between CHEU and CHUU, 1-year neurodevelopment was similar. Addressing IPV and food insecurity may provide benefits regardless of maternal HIV status. DTG use was associated with higher neurodevelopmental scores in CHEU, compared to EFV regimens, potentially contributing to a lack of neurodevelopmental difference between CHEU and CHUU.
HIV 暴露但未感染（CHEU）儿童的神经发育预测因素了解甚少。
2021 年 3 月至 2022 年 6 月期间，在肯尼亚的 7 个地点，在产后 6 周的护理访视期间招募了携带 HIV 和未携带 HIV 的母亲及其婴儿。使用马拉维发育评估工具评估婴儿的神经发育，包括社会、语言、精细运动和粗大运动领域。我们使用多变量线性混合效应模型，在调整潜在混杂因素并按地点进行聚类后，确定 1 岁神经发育评分与 HIV 和抗逆转录病毒治疗（ART）暴露以及家庭因素之间的关联。
在 1 岁评估时，CHEU（n=709）和 HIV 未暴露未感染的儿童（CHUU）（n=715）的中位年龄（52 周）和性别分布（49%对 52%为女性）相似。携带 HIV 的母亲年龄较大（31 岁对 27 岁），教育程度较低（50%对 26%为小学），且更有可能报告中度至重度粮食不安全（26%对 9%）（所有 p 值均<0.01）。与 CHUU 相比，CHEU 的语言评分更高（调整后的系数：0.23，95%置信区间：0.06，0.39），社会、精细和粗大运动评分相当。在所有儿童中，早产与粗大运动评分较低有关（调整后的系数：-1.38，95%置信区间：-2.05，-0.71），粮食不安全与社会评分较低有关（调整后的系数：-0.37，95%置信区间：-0.73，-0.01），母亲报告亲密伴侣暴力（IPV）与精细运动（调整后的系数：-0.76，95%置信区间：-1.40，-0.13）和粗大运动评分较低有关（调整后的系数：-1.07，95%置信区间：-1.81，-0.33）。在 CHEU 中，与 dolutegravir（DTG）暴露相比，妊娠期间使用依非韦伦（EFV）与粗大运动评分较低有关（调整后的系数：-0.51，95%置信区间：-1.01，-0.03）。精细和粗大运动评分也与单亲或丧偶母亲（调整后的系数：-0.45，95%置信区间：-0.87，-0.03）或已故或不在的父亲（调整后的系数：-0.81，95%置信区间：-1.58，-0.05）有关。
生物和社会因素与儿童神经发育有关。尽管 CHEU 和 CHUU 之间存在社会人口统计学差异，但 1 岁时的神经发育相似。解决 IPV 和粮食不安全问题可能会带来好处，无论母亲的 HIV 状况如何。与 EFV 方案相比，DTG 用于 CHEU 与更高的神经发育评分相关，这可能导致 CHEU 和 CHUU 之间神经发育差异缺乏。
