Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences.
Africa Academy for Public Health, Dar es Salaam, Tanzania.
AIDS. 2024 Nov 15;38(14):1947-1955. doi: 10.1097/QAD.0000000000003985. Epub 2024 Jul 30.
Assess the risk of death for offspring of pregnant women with HIV (PWHIV) and the association with sociodemographic, pregnancy, HIV-related, and birth factors.
We conducted a prospective cohort study of PWHIV on antiretroviral therapy (ART) and their offspring in urban Tanzania who were enrolled in a vitamin D trial conducted from June 2015 to October 2019.
We described rates of fetal, neonatal, and infant death and assessed risk factors for these outcomes with generalized estimating equations. We also estimated population-attributable risk percentages for the contribution of prematurity and small-for-gestational age (SGA) to neonatal and infant mortality.
Among 2299 PWHIV, there were a total of 136 fetal deaths (5.6%) and the stillbirth rate was 42.0 per 1000 total births. Among 2167 livebirths, there were 57 neonatal deaths (26.3 per 1000 livebirths) and 114 infant deaths (52.6 per 1000 livebirths). Twin birth was associated with neonatal death, while maternal CD4 + T-cell count <350 cells/μl in pregnancy was associated with infant death ( P -values < 0.05). As compared to term-appropriate-for-gestational age (AGA) births, the relative risks for neonatal mortality for term-SGA, preterm-AGA, and preterm-SGA infants were 2.07 [95% confidence interval (CI): 1.00-4.28], 2.87 (95% CI 1.54-5.35), and 7.15 (95% CI: 2.11-24.30), respectively. We estimated that 42.7% of neonatal and 29.4% of infant deaths were attributable to prematurity and SGA in the cohort.
The risk of death is high for offspring of PWHIV in Tanzania and the combination of prematurity and fetal growth restriction may account for nearly half of neonatal deaths.
评估感染艾滋病毒的孕妇（PWHIV）所生孩子的死亡风险，并分析其与社会人口学、妊娠、艾滋病毒相关和出生因素的关联。
我们对坦桑尼亚城市中接受抗逆转录病毒疗法（ART）的 PWHIV 及其子女进行了一项前瞻性队列研究，这些参与者参加了 2015 年 6 月至 2019 年 10 月期间进行的维生素 D 试验。
我们描述了胎儿、新生儿和婴儿死亡的发生率，并使用广义估计方程评估了这些结局的危险因素。我们还估计了早产和胎儿生长受限（SGA）对新生儿和婴儿死亡率的人群归因风险百分比。
在 2299 名 PWHIV 中，共有 136 例胎儿死亡（5.6%），死产率为每 1000 例总分娩 42.0 例。在 2167 例活产儿中，有 57 例新生儿死亡（每 1000 例活产儿 26.3 例）和 114 例婴儿死亡（每 1000 例活产儿 52.6 例）。双胞胎分娩与新生儿死亡有关，而孕妇妊娠时 CD4 + T 细胞计数 <350 个/μl 与婴儿死亡有关（P 值均<0.05）。与足月适当胎龄（AGA）出生相比，足月 SGA、早产 AGA 和早产 SGA 新生儿的死亡率相对风险分别为 2.07（95%CI：1.00-4.28）、2.87（95%CI 1.54-5.35）和 7.15（95%CI：2.11-24.30）。我们估计，该队列中近一半的新生儿和婴儿死亡归因于早产和胎儿生长受限。
坦桑尼亚的 PWHIV 所生孩子的死亡风险很高，早产和胎儿生长受限的结合可能导致近一半的新生儿死亡。
