Growth trajectories of breastfed HIV-exposed uninfected and HIV-unexposed children under conditions of universal maternal antiretroviral therapy: a prospective study
Growth trajectories of breastfed HIV-exposed uninfected and HIV-unexposed children under conditions of universal maternal antiretroviral therapy: a prospective study
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DOI：
10.1016/s2352-4642(19)30007-0
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发表时间：
2019-04-01
影响因子：
36.4
通讯作者：
Myer, Landon
中科院分区：
文献类型：
--
作者：
le Roux, Stanzi M.;Abrams, Elaine J.;Myer, Landon
背景：撒哈拉以南非洲地区每年有100多万未感染艾滋病毒的儿童出生。在目前普遍的母体抗逆转录病毒疗法(ART)和母乳喂养的政策下，关于这一人群生长受损的风险的数据很少。我们的目的是研究孕期启动抗逆转录病毒治疗的母亲所生的母乳喂养的HEU儿童的生长发育，并将其与来自同一社区的母乳喂养的未接触艾滋病毒的儿童的生长发育进行比较。方法在南非开普敦古古莱图的一家初级保健中心，对启动抗逆转录病毒治疗的HIV非感染和HIV感染的孕妇进行前瞻性队列调查。感染艾滋病毒的妇女是母婴健康抗逆转录病毒疗法(MCH-ART)研究的参与者，未感染艾滋病毒的孕妇是艾滋病毒未暴露-未感染(HU2)研究的参与者。所有妇女都在怀孕期间通过分娩进行了跟踪，直到计划在出生后第一周进行的早期产后访问。在这次访问中，招募了符合条件的母乳喂养母婴对，用于继续产后随访，直到大约12个月大。在6周左右，从3月到12月每隔3个月测量儿童人体尺寸。采用混合效应线性回归方法纵向比较HEU和HU儿童的年龄体重(WAZ)、年龄长度(LAZ)、身长体重(WLZ)、头围(BMI)和体重指数(BMI)Z得分。12个月时，对HEU和HU儿童中重度营养不良的比例进行横断面Logistic回归分析。MCH-ART已注册为临床试验。GOV，编号NCT01933477。2013年6月至2016年4月，884名哺乳母亲及其新生儿(HEU，n=471；HU，n=413)接受产后随访。排除12名HIV检测呈阳性的儿童，461名HEU和411名HU儿童共参加了4511次学习访问，平均每个儿童6次访问(IQR5-6)。出生特征相似(总体而言，872名早产儿中有94名[11%]
Background Over 1 million HIV-exposed uninfected (HEU) children are born in sub-Saharan Africa annually. Little data exist on the risk of impaired growth in this population under current policies of universal maternal antiretroviral therapy (ART) with breastfeeding. We aimed to study the growth of breastfed HEU children born to women who initiated ART during pregnancy and compare their growth with that of breastfed HIV-unexposed (HU) children drawn from the same community.Methods A prospective cohort of HIV-uninfected and HIV-infected pregnant women, who were initiating ART, were enrolled at their first antenatal care visit in a primary care centre in Gugulethu, Cape Town, South Africa. HIV infected women were participants of the Maternal Child Health Antiretroviral Therapy (MCH-ART) study, and HIV-uninfected pregnant women were participants in the HIV-Unexposed-Uninfected (HU2) study. All women were followed up during pregnancy, through delivery, to the early postnatal visit, which was scheduled for the first week after birth. At this visit, eligible breastfeeding mother-child pairs were recruited for continuation of postnatal follow-up until approximately age 12 months. Child anthropometry was measured at around 6 weeks, and every 3 months from month 3 to month 12. Weight-for-age (WAZ), length-for-age (LAZ), weight-for-length (WLZ), head circumference-for-age, and body-mass index-for-age Z scores were compared between HEU and HU children longitudinally using mixed effects linear regression. At 12 months, proportions of HEU and HU children with moderate or severe malnutrition were compared cross-sectionally using logistic regression. MCH-ART is registered with ClinicalTrials. gov, number NCT01933477.Findings Between June, 2013, and April, 2016, 884 breastfeeding mothers and their newborn babies (HEU, n=471; HU, n=413) were enrolled into postnatal follow-up. Excluding 12 children who tested HIV positive during follow-up, 461 HEU and 411 HU children attended 4511 study visits in total, with a median of 6 visits (IQR 5-6) per child. Birth characteristics were similar (overall, 94 [11%] of 872 preterm [