背景:对未感染HIV(CHEU)的儿童神经发育的预测因素了解甚少。
方法:在2021年3月至2022年6月期间,在肯尼亚的七个地点进行了为期6周的产后护理访视。使用马拉维发育评估工具评估婴儿神经发育,包括社会,语言,精细电机和粗大电机领域。我们使用多元线性混合效应模型来确定1年神经发育评分之间的关联,艾滋病毒和抗逆转录病毒疗法(ART)暴露,和家庭因素,针对潜在的混杂因素进行了调整,并被网站聚集。
结果:在1年评估时,CHEU(n=709)和未感染艾滋病毒的儿童(CHUU)(n=715)的中位年龄(52周)和性别分布(49%vs.52%女性)。感染艾滋病毒的母亲年龄较大(31vs.27年),受教育程度较低(50%与26%的主要),更有可能报告中度至重度粮食不安全(26%与9%)(均p<0.01)。相比于CHUU,CHEU的语言得分较高(调整系数:0.23,95%CI:0.06,0.39),社会可比,精细和粗略的运动分数。在所有的孩子中,早产与较低的运动总评分相关(调整系数:-1.38,95%CI:-2.05,-0.71),粮食不安全与较低的社会得分相关(调整系数:-0.37,95%CI:-0.73,-0.01),产妇报告的亲密伴侣暴力(IPV)与较低的精细运动得分相关(调整系数:-0.76,95%CI:-1.40,-0.13)和粗大运动得分相关(调整系数:-1.07,95%CI:-1.81,-0.33).在CHEU中,与dolutegravir(DTG)暴露相比,妊娠期间宫内依非韦伦(EFV)暴露与较低的粗大运动评分相关(调整系数:-0.51,95%CI:-1.01,-0.03).较低的精细和总运动分数也与单身或丧偶母亲(调整后的系数:-0.45,95%CI:-0.87,-0.03)或已故或缺席的父亲(调整后的系数:-0.81,95%CI:-1.58,-0.05)有关,分别。
结论:生物和社会因素与儿童神经发育有关。尽管CHEU和CHUU之间存在社会人口统计差异,1年神经发育相似。无论孕产妇感染艾滋病毒状况如何,解决IPV和粮食不安全问题都可能带来好处。使用DTG与CHEU较高的神经发育评分相关,与EFV方案相比,可能导致CHEU和CHUU之间缺乏神经发育差异。
Predictors of neurodevelopment among children who are HIV-exposed uninfected (
CHEU) are poorly understood.
Mothers with and without HIV and their children were enrolled during 6-week postnatal care visits across seven sites in Kenya between March 2021 and June 2022. Infant neurodevelopment was assessed using the Malawi Developmental Assessment Tool, including social, language, fine motor and gross motor domains. We used multivariate linear mixed effects models to identify associations between 1-year neurodevelopment scores, HIV and antiretroviral therapy (ART) exposures, and household factors, adjusted for potential confounders and clustered by the site.
At 1-year evaluation,
CHEU (n = 709) and children who are HIV-unexposed uninfected (CHUU) (n = 715) had comparable median age (52 weeks) and sex distribution (49% vs. 52% female). Mothers living with HIV were older (31 vs. 27 years), had lower education (50% vs. 26% primary) and were more likely to be report moderate-to-severe food insecurity (26% vs. 9%) (p < 0.01 for all). Compared to CHUU, CHEU had higher language scores (adjusted coeff: 0.23, 95% CI: 0.06, 0.39) and comparable social, fine and gross motor scores. Among all children, preterm birth was associated with lower gross motor scores (adjusted coeff: -1.38, 95% CI: -2.05, -0.71), food insecurity was associated with lower social scores (adjusted coeff: -0.37, 95% CI: -0.73, -0.01) and maternal report of intimate partner violence (IPV) was associated with lower fine motor (adjusted coeff: -0.76, 95% CI: -1.40, -0.13) and gross motor scores (adjusted coeff: -1.07, 95% CI: -1.81, -0.33). Among
CHEU, in utero efavirenz (EFV) exposure during pregnancy was associated with lower gross motor scores compared to dolutegravir (DTG) exposure (adjusted coeff: -0.51, 95% CI: -1.01, -0.03). Lower fine and gross motor scores were also associated with having a single or widowed mother (adjusted coeff: -0.45, 95% CI: -0.87, -0.03) or a deceased or absent father (adjusted coeff: -0.81, 95% CI: -1.58, -0.05), respectively.
Biologic and social factors were associated with child neurodevelopment. Despite socio-demographic differences between
CHEU and CHUU, 1-year neurodevelopment was similar. Addressing IPV and food insecurity may provide benefits regardless of maternal HIV status. DTG use was associated with higher neurodevelopmental scores in CHEU, compared to EFV regimens, potentially contributing to a lack of neurodevelopmental difference between
CHEU and CHUU.