Cassidy Adam R, Mayondi Gloria, Williams Paige L, Moabi Kebaiphe, LeMahieu Allison, Kamanga Naledi, Powis Kathleen M, Isquith Peter, Ramaabya Dinah, Banda Francis M, Makhema Joseph, Kammerer Betsy, Lockman Shahin
Department of Psychiatry & Psychology.
Department of Pediatric & Adolescent Medicine, Mayo Clinic, Rochester, MN, USA.
AIDS. 2025 Apr 1;39(5):609-617. doi: 10.1097/QAD.0000000000004111. Epub 2025 Jan 6.
To examine the impact of in-utero exposure to dolutegravir (DTG)-based or efavirenz (EFV)-based antiretroviral treatment (ART) on child neurodevelopmental outcomes.
Prospective cohort design, enrolling three cohorts of 2-year-olds: children HIV-negative born to mothers with HIV (CHEU) receiving either DTG-based or EFV-based three-drug ART during pregnancy, and children born to mothers without HIV (CHUU).
Primary child neurodevelopmental outcomes were assessed using the Bayley Scales of Infant and Toddler Development, Third Edition (BSID-III) and compared between cohorts using generalized estimating equation models adjusted for confounders. Children were classified as having an 'adverse ND outcome' if they scored at least 1 standard deviation (SD) below the mean or were unable to complete the BSID-III.
Five hundred and sixty-four participants (202 DTG-exposed, 202 EFV-exposed, 160 HIV-unexposed; mean age 25.7 months, 49% female). Mean (SD) Gross Motor scores were slightly lower among CHEU vs. CHUU [54.6 (3.6) vs. 55.6 (4.3)] and among EFV-exposed vs. DTG-exposed [54.3 (3.5) vs. 54.9 (3.6)]. CHEU were more likely to be classified as having an 'adverse' expressive language outcome [13.2 vs 7%, adjusted risk ratio (aRR) = 2.06, 95% confidence interval (CI) 1.05-4.03] than CHUU, but other neurodevelopmental outcomes were similar. DTG exposure was associated with less frequent 'adverse' classification in Cognitive (2.5 vs. 7.4%, aRR = 0.33, 95% CI 0.13-0.79) and Expressive Language domains (10.0 vs. 16.4%, aRR = 0.58, 95% CI 0.35, 0.95), compared to EFV exposure.
Two-year neurodevelopmental outcomes among Botswana children DTG-exposed, EFV-exposed, and HIV-unexposed were mostly comparable. Children exposed in utero to EFV-based ART had higher risk of 'adverse' cognitive and expressive language outcomes compared with children DTG-exposed.
研究子宫内暴露于基于度鲁特韦（DTG）或依非韦伦（EFV）的抗逆转录病毒治疗（ART）对儿童神经发育结局的影响。
前瞻性队列研究设计，纳入三组2岁儿童：感染HIV母亲所生的HIV阴性儿童（CHEU），其母亲在孕期接受基于DTG或EFV的三联ART治疗，以及未感染HIV母亲所生的儿童（CHUU）。
使用贝利婴幼儿发展量表第三版（BSID-III）评估儿童主要神经发育结局，并使用针对混杂因素进行调整的广义估计方程模型在各队列之间进行比较。如果儿童得分比平均值低至少1个标准差（SD）或无法完成BSID-III，则被分类为具有“不良神经发育结局”。
564名参与者（202名暴露于DTG，202名暴露于EFV，160名未暴露于HIV；平均年龄25.7个月，49%为女性）。与CHUU相比，CHEU的平均（SD）大运动得分略低[54.6（3.6）对55.6（4.3）]，与暴露于DTG的儿童相比，暴露于EFV的儿童的得分略低[54.3（3.5）对54.9（3.6）]。与CHUU相比，CHEU更有可能被分类为具有“不良”表达性语言结局[13.2%对7%，调整风险比（aRR）=2.06，95%置信区间（CI）1.05 - 4.03]，但其他神经发育结局相似。与暴露于EFV相比，暴露于DTG的儿童在认知（2.5%对7.4%，aRR = 0.33，95%CI 0.13 - 0.79）和表达性语言领域（10.0%对16.4%，aRR = 0.58，95%CI 0.35，0.95）中“不良”分类的频率较低。
博茨瓦纳暴露于DTG、暴露于EFV和未暴露于HIV的儿童的两年神经发育结局大多具有可比性。与暴露于DTG的儿童相比，子宫内暴露于基于EFV的ART的儿童出现“不良”认知和表达性语言结局的风险更高。
