In-utero exposure to antiretrovirals and neurodevelopment among HIV-exposed-uninfected children in Botswana
In-utero exposure to antiretrovirals and neurodevelopment among HIV-exposed-uninfected children in Botswana
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DOI：
10.1097/qad.0000000000001790
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发表时间：
2018-06-01
期刊：
影响因子：
3.8
通讯作者：
Kammerer, Betsy
中科院分区：
文献类型：
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作者：
Chaudhury, Sumona;Mayondi, Gloria K.;Kammerer, Betsy
目的：关于宫内暴露于母体联合抗逆转录病毒药物的影响，存在明确的数据。我们比较了子宫内暴露于艾滋病毒的未感染（HEU）儿童接受三种药物联合抗逆转录病毒治疗（ART）与齐多夫定（ZDV）单药治疗的神经发育结果。设计：儿童神经发育的前瞻性研究，嵌套在两个队列中博茨瓦纳感染艾滋病毒的母亲及其子女方法：Tshipidi和Mma Bana研究招募了怀孕期间感染艾滋病毒的妇女，并对其高浓缩铀儿童进行了24个月的随访。母亲在怀孕期间服用三种药物ART或ZDV。接触抗逆转录病毒药物的婴儿大多数是母乳喂养的，接触ZDV的婴儿是配方奶粉喂养的。神经发育的结果，在24个月使用贝利婴幼儿发展量表第三版（Bayley-III）和发展里程碑检查表（DMC），进行了比较，在调整后的线性回归根据抗逆转录病毒exposure.Results：598 HEU儿童有效的神经发育评估，382 ART暴露和210 ZDV暴露。ART暴露组与ZDV暴露组的校正后平均Bayley-III评分相似，校正后平均差异（95%置信区间）：Bayley-III认知：-0.3（-1.4，0.9）;粗大运动：0.8（-0.1，1.7）;精细电机：0.5（-0.2，1.3）;表达性语言：0.7（-0.3，1.7）;接受性语言：0.1（-0.7，0.8）;和DMC运动：0.0（-0.5，0.6）;精细运动：0.3（-0.3，0.8）;语言：-0.1（-0.5，0.4）;个人-社交：0.2（-0.7，1.1）。同样，当仅限于配方奶粉喂养的儿童在一个队列（Tshipidi），有调整后的平均scores.Conclusion：在24个月大的神经发育结果是相似的ART暴露与ZDV暴露的高浓缩铀儿童。母乳喂养的母亲ART似乎对神经发育没有不良影响。版权所有（C）2018威科医疗集团All rights reserved.
Objective: Conflicting data exist regarding the impact of in-utero exposure to maternal combination antiretrovirals. We compared neurodevelopmental outcomes between HIV-exposed-uninfected (HEU) children exposed in utero to three-drug combination antiretroviral therapy (ART) vs. zidovudine (ZDV) monotherapy.Design: Prospective study of child neurodevelopment, nested within two cohorts of HIV-infected mothers and their children in Botswana (one observational, one interventional).Methods: The Tshipidi and Mma Bana studies enrolled HIV-infected women during pregnancy and followed their HEU children for 24 months. Mothers took three-drug ART or ZDV during pregnancy. ART-exposed babies were mostly breastfed, and ZDV-exposed were formula-fed. Neurodevelopmental outcomes, measured at 24 months using Bayley Scales of Infant and Toddler Development Third Edition (Bayley-III) and Development Milestones Checklist (DMC), were compared in adjusted linear regression according to antiretroviral exposure.Results: Of 598 HEU children with valid neurodevelopment assessments, 382 were ART-exposed and 210 were ZDV-exposed. Adjusted mean Bayley-III scores were similar among ART-exposed vs. ZDV-exposed, with adjusted mean differences (95% confidence interval): Bayley-III Cognitive: -0.3 (-1.4, 0.9); Gross Motor: 0.8 (-0.1, 1.7); Fine Motor: 0.5 (-0.2, 1.3); Expressive Language: 0.7 (-0.3, 1.7); Receptive Language: 0.1 (-0.7, 0.8); and DMC Locomotor: 0.0 (-0.5, 0.6); Fine Motor: 0.3 (-0.3, 0.8); Language: -0.1 (-0.5, 0.4); Personal-Social: 0.2 (-0.7, 1.1). Similarly, when restricted to formula-fed children in one cohort (Tshipidi), there were no differences in adjusted mean scores.Conclusion: Neurodevelopmental outcomes at 24 months of age were similar in ART-exposed vs. ZDV-exposed HEU children. Maternal ART with breastfeeding does not appear to have an adverse effect on neurodevelopment. Copyright (C) 2018 Wolters Kluwer Health, Inc. All rights reserved.