Nozyce M, Hittelman J, Muenz L, Durako S J, Fischer M L, Willoughby A
Bronx Lebanon Hospital Center, Department of Pediatrics, New York 10457.
Pediatrics. 1994 Dec;94(6 Pt 1):883-91.
To determine the timing, extent, and magnitude of neurodevelopmental problems in children with perinatal HIV infection compared to similar uninfected children of HIV-infected women and controls.
Neurodevelopmental assessments during the first 24 months of life for 21 HIV-infected children born to HIV-infected mothers, 65 seroreverted children born to HIV-infected mothers, and 95 non-HIV-infected children born to non-HIV-infected mothers were analyzed. Neurodevelopment was assessed by using the Bayley Scales of Infant Development beginning at 3 months of age. Kent Scoring Adaptation was also utilized. A two-stage Hierarchical Linear Model was used for analysis of neurodevelopmental scores.
In the initial comparison of these three groups, infected children had significantly lower scores on the Mental Development Index (MDI) and Psychomotor Development Index (PDI) than the other two groups. The HIV-infected children were further classified into HIV-infected without Centers for Disease Control-defined AIDS, those with lymphoid interstitial pneumonitis (LIP) only as their AIDS-defining illness, and children with an AIDS-defining diagnosis other than LIP in the first 24 months. The children with LIP-only AIDS and the infected children without AIDS on average were not significantly different from the seroreverters or the controls on MDI or PDI, while the children with non-LIP AIDS had significantly lower scores after 3 months of age. Analysis of the Kent scores indicated that the decrement in the non-LIP AIDS children was seen in all five functional domains.
Children with serious HIV symptomatology appear to be at very high risk for serious developmental impairments, HIV-infected children not highly symptomatic have relatively normal neurodevelopment, and uninfected children of HIV-infected mothers do not appear to be adversely affected by the mother's HIV infection.
与感染HIV女性的未感染儿童及对照组儿童相比，确定围产期感染HIV儿童神经发育问题的发生时间、程度和严重程度。
分析了21名感染HIV母亲所生的HIV感染儿童、65名感染HIV母亲所生的血清学转阴儿童以及95名未感染HIV母亲所生的非HIV感染儿童在出生后24个月内的神经发育评估情况。从3个月大开始使用贝利婴儿发育量表评估神经发育情况。还采用了肯特评分法。使用两阶段分层线性模型分析神经发育得分。
在这三组的初步比较中，感染儿童的心理发展指数（MDI）和精神运动发育指数（PDI）得分显著低于其他两组。HIV感染儿童进一步分为未患美国疾病控制与预防中心定义的艾滋病的HIV感染儿童、仅以淋巴间质性肺炎（LIP）作为艾滋病定义疾病的儿童以及在出生后24个月内患有除LIP以外的艾滋病定义诊断的儿童。仅患有LIP型艾滋病的儿童和未患艾滋病的感染儿童在MDI或PDI上平均与血清学转阴儿童或对照组没有显著差异，而患有非LIP型艾滋病的儿童在3个月大后得分显著较低。肯特评分分析表明，非LIP型艾滋病儿童在所有五个功能领域的得分都有所下降。
有严重HIV症状的儿童似乎有很高的严重发育障碍风险，症状不严重的HIV感染儿童神经发育相对正常，感染HIV母亲的未感染儿童似乎未受到母亲HIV感染的不利影响。
