Tenofovir exposure in utero and linear growth in HIV-exposed, uninfected infants.
Tenofovir exposure in utero and linear growth in HIV-exposed, uninfected infants.
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DOI：
10.1097/qad.0000000000001302
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发表时间：
2017-01-02
期刊：
影响因子：
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通讯作者：
Myer L
中科院分区：
文献类型：
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作者：
M le Roux S;Jao J;Brittain K;Phillips TK;Olatunbosun S;Ronan A;Zerbe A;Abrams EJ;Myer L
替诺福韦 (TDF) 会影响骨骼健康，并广泛用于妊娠期，但有关子宫内 TDF 暴露影响的数据有限。我们研究了子宫内 TDF 暴露持续时间与暴露于 HIV 的未感染 (HEU) 婴儿的线性生长之间的关联。南非开普敦初级保健服务机构对一组孕妇进行了前瞻性队列研究，这些孕妇开始接受含 TDF 的治疗方案，并对其母乳喂养的婴儿进行了为期 12 个月的随访。年龄别身长 z 得分 (LAZ) 根据婴儿出生时报告的身长计算得出，并在 6、12、24、36 和 48 周时测量，使用芬顿和世界卫生组织标准。线性混合效应模型用于检查 TDF 暴露持续时间与 LAZ 随时间的关系。在 464 对单胎母婴中（ART 开始时的中值 CD4，346 个细胞/μL；病毒载量 (VL)，4.0 log10 拷贝/ml），子宫内 TDF 暴露的中位持续时间为 16.7 周（四分位数范围，IQR 11.0-22.0），其中 31%、44% 和 25% 的婴儿暴露于 <12、分别为 12-22 周和 >22 周的 TDF。总体而言，12% 的儿童在 48 周时发育迟缓 (LAZ<-2)。暴露时间与 LAZ 无关：>22 周与 <12 周的调整平均差为 -0.12（95% CI：-0.47；0.23）； 12-22 周 vs <12 周，-0.06（95% CI：-0.35；0.24）。 ART 开始时，母体 VL 每增加对数，平均 LAZ 降低 0.15（95% CI：-0.29；-0.0001）。这些数据表明子宫内 TDF 暴露持续时间与早期线性生长之间没有关联。
Tenofovir (TDF) affects bone health and is widely used in pregnancy but data are limited on the effects of TDF exposure in utero. We examined the association between duration of in utero TDF exposure and linear growth in HIV-exposed, uninfected (HEU) infants. A prospective cohort of pregnant women initiating TDF-containing regimens at primary care services in Cape Town, South Africa were enrolled and followed with their breastfeeding infants through 12 months postpartum. Length-for-age z-scores (LAZ) were calculated from infant lengths reported at birth and measured at 6, 12, 24, 36 and 48 weeks, using Fenton and World Health Organization standards. Linear mixed effects models were used to examine the association between duration of TDF exposure and LAZ over time. In 464 singleton mother-infant pairs (median CD4 at ART initiation, 346 cells/μL; viral load (VL), 4.0 log10 copies/ml), the median duration of in utero TDF exposure was 16.7 weeks (interquartile range, IQR 11.0-22.0) with 31%, 44% and 25% of infants exposed to <12, 12-22 and >22 weeks of TDF respectively. Overall, 12% of children were stunted (LAZ<-2) at 48 weeks. Duration of exposure was not associated with LAZ: adjusted mean difference for >22 vs <12 wks, -0.12 (95% CI: -0.47; 0.23); 12-22 vs <12 wks, -0.06 (95% CI: -0.35; 0.24). Mean LAZ was 0.15 lower per log increase in maternal VL at ART initiation (95% CI: -0.29; -0.0001). These data suggest no association between duration of TDF exposure in utero and early linear growth.