Lwanga Christopher, Aber Peace, Tickell Kirkby D, Ngari Moses M, Mukisa John, Atuhairwe Michael, Brown Lindsay, Mupere Ezekiel, Potani Isabel, Shahrin Lubaba, Morgan Brooks, Singa Benson O, Nankabirwa Victoria, Mugambe Richard K, Mukasa Zakaria, Walson Judd L, Berkley James A, Lancioni Christina L
Uganda-Case Western Reserve University Research Collaboration, Kampala, Uganda.
The Childhood Acute Illness and Nutrition (CHAIN) Network, Nairobi, Kenya.
BMC Med. 2024 Dec 3;22(1):573. doi: 10.1186/s12916-024-03790-5.
Although mortality risk associated with HIV is well described, HIV-exposed uninfected (HEU) young children are also at increased risk of hospitalization and death as compared to HIV-unexposed uninfected (HUU) children. The drivers of poor outcomes among HEU children remain unknown, limiting the development of interventions to support this vulnerable population.
We performed a secondary analysis of data from a large multi-country prospective cohort [Childhood Acute Illness and Nutrition (CHAIN) Network] study. Data from 5 sites in Uganda, Kenya, and Malawi were included. Hospitalized children aged 2-23 months were followed from an index admission for 6 months after discharge to determine acute and long-term outcomes. Using perinatal HIV exposure (HEU and HUU) as the primary exposure and adjusting for child, caregiver, and household characteristics, we compared inpatient and 30-day survival outcomes, nutritional status, hospital length of stay, illness severity, and utilization of inpatient resources.
We included 1486 children: 217 HEU and 1269 HUU. HEU children had an increased risk of mortality both during hospitalization [adjusted OR 1.96, 95% CI (1.14-3.37)] and in the 30 days following hospital admission [adjusted hazard ratio 2.20, 95% CI (1.10-4.42)]. Wasting and stunting were more frequent in HEU than HUU children, with adjusted OR 1.41, 95% CI (1.03-1.95) and adjusted OR 1.91, 95% CI (1.34-2.70), respectively. HEU children were also more likely to have a prolonged hospital stay compared to HUU children [adjusted OR 1.58, 95% CI (1.08-2.29)], although admission diagnoses, illness severity at admission, and use of inpatient resources (supplemental oxygen, nasogastric tube, and second-line antibiotics) did not differ significantly between groups.
HEU children are more likely to die during hospitalization and within 30 days of admission, to be wasted and stunted upon hospital admission, and to require a prolonged hospital stay, as compared to HUU children. Hospitals in settings with a high prevalence of women-living-with-HIV should ensure that maternal HIV status is established among children requiring admission and build capacity to provide additional hospital monitoring and early post-discharge support for HEU children.
尽管与艾滋病毒相关的死亡风险已有充分描述，但与未接触艾滋病毒的未感染儿童（HUU）相比，接触过艾滋病毒的未感染儿童（HEU）住院和死亡风险也有所增加。HEU儿童不良结局的驱动因素尚不清楚，这限制了支持这一脆弱人群的干预措施的发展。
我们对一项大型多国前瞻性队列研究[儿童急性疾病与营养（CHAIN）网络]的数据进行了二次分析。纳入了乌干达、肯尼亚和马拉维5个地点的数据。对2至23个月的住院儿童从首次入院起随访出院后6个月，以确定急性和长期结局。以围产期艾滋病毒暴露情况（HEU和HUU）作为主要暴露因素，并对儿童、照料者和家庭特征进行调整，我们比较了住院期间和30天生存结局、营养状况、住院时间、疾病严重程度以及住院资源的使用情况。
我们纳入了1486名儿童：217名HEU儿童和1269名HUU儿童。HEU儿童在住院期间死亡风险增加[调整后的比值比为1.96，95%置信区间（1.14 - 3.37）]，在入院后30天内死亡风险也增加[调整后的风险比为2.20，95%置信区间（1.10 - 4.42）]。与HUU儿童相比，HEU儿童消瘦和发育迟缓更为常见，调整后的比值比分别为1.41，95%置信区间（1.03 - 1.95）和1.91，95%置信区间（1.34 - 2.70）。与HUU儿童相比，HEU儿童住院时间也更可能延长[调整后的比值比为1.58，95%置信区间（1.08 - 2.29）]，尽管两组之间的入院诊断、入院时疾病严重程度以及住院资源（补充氧气、鼻胃管和二线抗生素）的使用情况没有显著差异。
与HUU儿童相比，HEU儿童在住院期间和入院后30天内死亡的可能性更高，入院时更可能消瘦和发育迟缓，且需要更长的住院时间。在艾滋病毒感染女性患病率较高的地区，医院应确保在需要入院的儿童中确定其母亲的艾滋病毒感染状况，并建立能力为HEU儿童提供额外的住院监测和出院后早期支持。
