Neurodevelopment of breastfed HIV-exposed uninfected and HIV-unexposed children in South Africa.
Neurodevelopment of breastfed HIV-exposed uninfected and HIV-unexposed children in South Africa.
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DOI：
10.1097/qad.0000000000001872
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发表时间：
2018-08-24
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：
le Roux SM;Donald KA;Brittain K;Phillips TK;Zerbe A;Nguyen KK;Strandvik A;Kroon M;Abrams EJ;Myer L
评估母乳喂养的HIV暴露未感染（HEU）和母乳喂养的HIV未暴露（HU）儿童在普遍母亲抗逆转录病毒治疗（ART）背景下的神经发育。对母乳喂养的HEU和HU母婴对进行产前登记和随访至产后12-18个月的前瞻性研究。南非，开普敦，城郊社区。HEU（n=215）和HU（n=306）儿童。认知、运动和语言发展中位数为13（IQR 12-14）月龄：连续和二分BSID-III评分（Bayley婴幼儿发育量表第3版;延迟定义为综合评分<85）早产发生率高浓缩铀和高浓缩铀儿童的PTD（PTD，<37周）相似（11%对9%，p=0.31;中位妊娠期39周）; 48%是男孩。高浓缩铀与高浓缩铀儿童的中位母乳喂养时间较短（6个月比10个月）。所有感染艾滋病毒的母亲在产前开始终身抗逆转录病毒治疗（TDF/FTC/EFV）。在粗分析和校正分析中，高血压性溃疡（相对于高血压性溃疡）儿童认知延迟[OR 2.28（95%CI 1.13-4.60）]和运动延迟[OR 2.10（95%CI 1.03-4.28）]的几率更高，但语言延迟的几率不高。PTD改变了运动发育的这种关系：与足月HU相比，足月HEU儿童的延迟几率相似，早产HU儿童的延迟几率增加5倍（aOR 4.73，95% CI 1.32; 16.91），早产HEU儿童增加16倍（aOR 16.35，95% CI 5.19; 51.54）。尽管母亲普遍接受抗逆转录病毒疗法和母乳喂养，但高浓缩铀幼儿认知和运动迟缓的风险可能会增加;早产儿可能特别脆弱。
To assess neurodevelopment of breastfed HIV-exposed uninfected (HEU) and breastfed HIV-unexposed (HU) children in the context of universal maternal antiretroviral therapy (ART). Prospective study with antenatal enrolment and follow-up of breastfeeding HEU and HU mother-infant pairs through 12–18 months postpartum. Peri-urban community, Cape Town, South Africa. HEU (n=215) and HU (n=306) children. Cognitive, motor and language development at median 13 (IQR 12–14) months of age: continuous and dichotomous BSID-III scores (Bayley Scales of Infant and Toddler Development 3rd edition; delay defined as composite score <85) Incidence of preterm delivery (PTD, <37 weeks) was similar among HEU and HU children (11% vs. 9%, p=0.31; median gestation 39 weeks); 48% were boys. Median breastfeeding duration was shorter among HEU vs. HU children (6 vs. 10 months). All HIV-infected mothers initiated lifelong ART (TDF/FTC/EFV) antenatally. HEU (vs. HU) children had higher odds of cognitive delay [OR 2.28 (95%CI 1.13–4.60)] and motor delay [OR 2.10 (95% CI 1.03–4.28)], but not language delay, in crude and adjusted analysis. PTD modified this relationship for motor development: compared to term HU, term HEU children had similar odds of delay, preterm HU children had 5-fold increased odds of delay (aOR 4.73, 95% CI 1.32; 16.91) and preterm HEU children, 16-fold (aOR 16.35, 95% CI 5.19; 51.54). Young HEU children may be at increased risk for cognitive and motor delay despite universal maternal ART and breastfeeding; those born preterm may be particularly vulnerable.