In-utero HIV exposure and cardiometabolic health among children 5-8 years: findings from a prospective birth cohort in South Africa.
In-utero HIV exposure and cardiometabolic health among children 5-8 years: findings from a prospective birth cohort in South Africa.
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DOI：
10.1097/qad.0000000000003412
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发表时间：
2023-01-01
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评估宫内 HIV 暴露是否与 5-8 岁时不良心脏代谢健康结果相关。前瞻性队列研究。我们从德拉肯斯坦儿童健康研究（南非开普敦的一项纵向出生队列研究）中随机招募了暴露于艾滋病毒但未感染（HEU）和未暴露于艾滋病毒的儿童样本，进行心脏代谢健康试点研究。结果由训练有素的研究人员使用 HOMA-IR 进行评估，包括：人体测量、身体成分和体型、血压、空腹血糖、HbA1c、血脂和胰岛素抵抗。我们使用多变量线性和对数二项式回归来估计 HIV 暴露与心脏代谢结果之间的关联，并根据儿童年龄、性别、身高、体型和母亲因素进行适当调整。我们纳入了 260 名儿童（HEU n = 100，未暴露于 HIV 的 n = 160）。 HEU 儿童的母亲年龄较大（中位年龄 30 岁与 26 岁），因 HIV 暴露状况而导致的胎龄和出生时体型差异极小。在多变量分析中，HEU儿童的年龄别体重（平均差-0.35，95%置信区间-0.66，-0.05）和年龄别身高（平均差-0.29，95%置信区间-0.56，-0.03；z分数）较低。 HIV暴露状态在肥胖、葡萄糖代谢受损或血脂水平方面没有差异。总体而言，12% 的儿童血压超过 90%，且 HIV 暴露状况没有差异。总体而言，在南非队列中，HEU 和未暴露于 HIV 的儿童之间的心脏代谢结果几乎没有差异。尽管这些发现令人安心，但随着 HEU 和未接触 HIV 的儿童进入青春期并且心脏代谢风险轨迹逐渐确定，监测心脏代谢健康也很重要。
To evaluate if in-utero HIV exposure is associated with adverse cardiometabolic health outcomes at 5–8 years of age. Prospective cohort study. We enrolled a random sample of HIV-exposed but uninfected (HEU) and HIV-unexposed children from the Drakenstein Child Health study, a longitudinal birth cohort study in Cape Town, South Africa, in a cardiometabolic health pilot study. Outcomes were assessed by trained study staff and included: anthropometry, body composition and size, blood pressure, fasting plasma glucose, HbA1c, lipids, and insulin resistance using HOMA-IR. We used multivariable linear and log-binomial regression to estimate associations between HIV-exposure and cardiometabolic outcomes, adjusted for child age, sex, height, body size, and maternal factors as appropriate. We included 260 children (HEU n = 100, HIV-unexposed n = 160). HEU children had older mothers (median age 30 vs. 26 years), with minimal differences in gestational age and size at birth by HIV-exposure status. In multivariable analyses, HEU children had lower weight-for-age (mean difference −0.35, 95% confidence interval −0.66, −0.05), and height-for-age (mean difference −0.29, 95% confidence interval −0.56, −0.03; z-scores). There were no differences in adiposity, impaired glucose metabolism, or lipid levels by HIV-exposure status. Overall, 12% of children had blood pressure more than 90th percentile, with no differences by HIV-exposure status. Overall, there were few differences in cardiometabolic outcomes between HEU and HIV-unexposed children in this South African cohort. Although these findings are reassuring, monitoring of cardiometabolic health is important as HEU and HIV-unexposed children enter adolescence and cardiometabolic risk trajectories become established.