Department of Internal Medicine and Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA.
Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
J Int AIDS Soc. 2023 Oct;26 Suppl 4(Suppl 4):e26165. doi: 10.1002/jia2.26165.
Studies have reported a higher risk of suboptimal neurodevelopment among children who are HIV-exposed uninfected (HEU) compared to children HIV-unexposed uninfected (HUU). Actual academic performance among school-aged children by HIV exposure status has not been studied.
Academic performance in Mathematics, Science, English, Setswana and overall among children enrolled in the Botswana-based FLOURISH study who were attending public primary school and ranging in age from 7.1 to 14.6 years were compared by HIV exposure status using a Cochran-Mantel-Haenszel test. Lower academic performance was defined as a grade of "C" or lower (≤60%). Unadjusted and adjusted logistic regression models were fit to assess for an association between HIV exposure and lower academic performance.
Between April 2021 and December 2022, 398 children attending public primary school enrolled in the FLOURSH study, 307 (77%) were HEU. Median age was 9.4 years (IQR 8.9-10.2). Only 17.9% of children HEU were breastfeed versus 100% of children HUU. Among children HEU, 80.3% had foetal exposure to three-drug antiretroviral treatment, 18.7% to zidovudine only and 1.0% had no antiretroviral exposure. Caregivers of children HEU were older compared to caregivers of children HUU (median 42 vs. 36 years) and more likely to have no or primary education only (15.0% vs. 1.1%). In unadjusted analyses, children HEU were more likely to have lower overall academic performance compared to their children HUU (odds ratio [OR]: 1.96 [95% confidence interval (CI): 1.16, 3.30]), and lower performance in Mathematics, Science and English. The association was attenuated after adjustment for maternal education, caregiver income, breastfeeding, low birth weight and child sex (aOR: 1.86 [95% CI: 0.78, 4.43]).
In this Botswana-based cohort, primary school academic performance was lower among children HEU compared to children HUU. Biological and socio-demographic factors, including child sex, appear to contribute to this difference. Further research is needed to identify modifiable contributors, develop screening tools to identify the risk of poor academic performance and design interventions to mitigate risk.
研究报告称，与 HIV 未感染的未暴露儿童（HUU）相比，HIV 暴露但未感染的儿童（HEU）的神经发育不良风险更高。尚未研究按 HIV 暴露状态划分的学龄儿童的实际学业成绩。
使用 Cochran-Mantel-Haenszel 检验比较了参加博茨瓦纳 FLOURISH 研究并正在公立小学就读、年龄在 7.1 至 14.6 岁之间的儿童的数学、科学、英语、茨瓦纳语和总体学术表现，按 HIV 暴露状态进行比较。较低的学业成绩定义为成绩为“C”或更低（≤60%）。未调整和调整后的逻辑回归模型用于评估 HIV 暴露与较低学业成绩之间的关联。
2021 年 4 月至 2022 年 12 月，共有 398 名在 FLOURSH 研究中就读公立小学的儿童入组，其中 307 名（77%）为 HEU。中位年龄为 9.4 岁（IQR 8.9-10.2）。只有 17.9%的 HEU 儿童接受过母乳喂养，而 100%的 HUU 儿童接受过母乳喂养。在 HEU 儿童中，80.3%的儿童在胎儿期接受了三药抗逆转录病毒治疗，18.7%的儿童接受了齐多夫定治疗，1.0%的儿童未接受抗逆转录病毒治疗。与 HUU 儿童的照顾者相比，HEU 儿童的照顾者年龄更大（中位数为 42 岁 vs. 36 岁），并且更有可能只接受过无或小学教育（15.0% vs. 1.1%）。在未调整的分析中，与 HUU 儿童相比，HEU 儿童的整体学业成绩更有可能较低（比值比 [OR]：1.96 [95%置信区间（CI）：1.16，3.30]），并且在数学、科学和英语方面的表现也较低。调整母亲教育、照顾者收入、母乳喂养、低出生体重和儿童性别后，这种关联减弱（调整后的比值比[aOR]：1.86 [95%CI：0.78，4.43]）。
在这项博茨瓦纳队列研究中，与 HUU 儿童相比，HEU 儿童的小学学业成绩较低。包括儿童性别在内的生物学和社会人口统计学因素似乎促成了这一差异。需要进一步研究以确定可改变的贡献因素，开发识别学业成绩不良风险的筛查工具，并设计减轻风险的干预措施。
