Abrams E J, Matheson P B, Thomas P A, Thea D M, Krasinski K, Lambert G, Shaffer N, Bamji M, Hutson D, Grimm K
Harlem Hospital, New York, NY, USA.
Pediatrics. 1995 Sep;96(3 Pt 1):451-8.
Differences in newborn outcome measures for human immunodeficiency virus (HIV)-1-infected and HIV-1-exposed but uninfected infants have been found in several studies, but not in others. Eighty-four infected and 248 uninfected children born to HIV-1-seropositive mothers followed prospectively in a multicenter, perinatal HIV-1 transmission cohort study were compared for differences in maternal demographics, health status, and newborn outcome measures, including delivery complications, physical examination findings, neonatal complications, and laboratory results.
Mothers of HIV-1-infected infants were more likely than those of uninfected infants to have acquired immunodeficiency syndrome (AIDS) diagnosed through 2 weeks postpartum (21% vs 11%, P = .04); the transmission rate for the 38 women with AIDs was 37% compared with 22% for the 245 women without AIDS. Two of 27 (7%) women receiving zidovudine during pregnancy had infected infants compared with 73 (27%) of 275 women who did not receive zidovudine (P = .033). Mean gestational age was significantly lower among HIV-1-infected (37 weeks) than among uninfected infants (38 weeks; P < .001). Infected infants had significantly higher rates of prematurity (gestational age less than 37 weeks) (33% vs 19%, P = .01) and extreme prematurity (gestational age less than 34 weeks) (18% vs 6%, P = .001) than uninfected infants. Infection was associated with lower birth weight (2533 g vs 2862 g, P < .001) and smaller head circumference (32.0 cm vs 33.1 cm, P = .001). HIV-1-infected infants were significantly more likely to be small for gestational age (26% vs 16%, P = .04) and low birth weight (less than 2500 g) (45% vs 29%, P = .006) than infants who were uninfected. Twenty-two (26%) HIV-1-infected children died during a median follow-up of 27.6 months (range 1.9 to 98.3 months). Prematurity was predictive of survival: by Kaplan-Meier, an estimated 55% (95% confidence interval, 31% to 72%) of preterm infected children survived to 24 months compared with 84% (95% confidence interval, 70% to 92%) of full-term infected children (P = .005).
Infants born to women with AIDS are at higher risk for HIV-1 infection than are infants born to HIV-1-infected women with AIDS not yet diagnosed. Women receiving zidovudine appear less likely to transmit HIV-1 to their infants. Significantly higher rates of prematurity and intrauterine growth retardation were found among HIV-1-infected infants than among those in the uninfected, HIV-1-exposed control group. Prematurity was associated with shortened survival in HIV-1-infected infants. Measures of intrauterine growth and gestation appear to be important predictors of HIV-1 infection status for seropositive infants and of prognosis for the infected infant.
在多项研究中发现，感染人类免疫缺陷病毒1型（HIV-1）的婴儿与暴露于HIV-1但未感染的婴儿在新生儿结局指标上存在差异，但也有其他研究未发现此类差异。在一项多中心围产期HIV-1传播队列研究中，对84例感染HIV-1的儿童和248例未感染HIV-1的儿童进行了前瞻性随访，这些儿童均为HIV-1血清阳性母亲所生。比较了两组母亲的人口统计学特征、健康状况以及新生儿结局指标，包括分娩并发症、体格检查结果、新生儿并发症和实验室检查结果。
与未感染婴儿的母亲相比，感染HIV-1婴儿的母亲在产后2周内被诊断为获得性免疫缺陷综合征（AIDS）的可能性更高（21%对11%，P = 0.04）；38例患有AIDS的女性的传播率为37%，而245例未患AIDS的女性的传播率为22%。27例孕期接受齐多夫定治疗的女性中有2例（7%）所生婴儿感染了HIV-1，而275例未接受齐多夫定治疗的女性中有73例（27%）所生婴儿感染了HIV-1（P = 0.033）。HIV-1感染婴儿的平均孕周（37周）显著低于未感染婴儿（38周；P < 0.001）。与未感染婴儿相比，感染婴儿的早产（孕周小于37周）率（33%对19%，P = 0.01）和极早产（孕周小于34周）率（18%对6%，P = 0.001）显著更高。感染与较低的出生体重（2533克对2862克，P < 0.001）和较小的头围（32.0厘米对33.1厘米，P = 0.001）相关。与未感染婴儿相比，HIV-1感染婴儿的小于胎龄儿发生率（26%对16%，P = 0.04）和低出生体重（小于2500克）发生率（45%对29%，P = 0.006）显著更高。在中位随访27.6个月（范围1.9至98.3个月）期间，22例（26%）HIV-1感染儿童死亡。早产是生存的预测因素：根据Kaplan-Meier法估计，早产感染儿童中约55%（95%置信区间，31%至72%）存活至24个月，而足月感染儿童的这一比例为84%（95%置信区间，70%至92%）（P = 0.005）。
与尚未诊断出AIDS的HIV-1感染女性所生婴儿相比, AIDS女性所生婴儿感染HIV-1的风险更高。接受齐多夫定治疗的女性向其婴儿传播HIV-1的可能性似乎较小。与未感染的HIV-1暴露对照组婴儿相比，HIV-1感染婴儿的早产率和宫内生长迟缓率显著更高。早产与HIV-1感染婴儿的生存时间缩短相关。宫内生长和孕周指标似乎是血清阳性婴儿HIV-1感染状态以及感染婴儿预后的重要预测因素。
