Emily R Begnel, Ednah Ojee, Judy Adhiambo, Eliza Mabele, Brenda Wandika, Vincent Ogweno, Efrem S Lim, Soren Gantt, John Kinuthia, Dara A Lehman, Jennifer Slyker, Dalton Wamalwa
{"title":"Linda Kizazi研究：在普遍抗逆转录病毒治疗时代，未感染艾滋病毒和未感染艾滋病毒的儿童从出生到两岁的发病率和死亡率的比较。","authors":"Emily R Begnel, Ednah Ojee, Judy Adhiambo, Eliza Mabele, Brenda Wandika, Vincent Ogweno, Efrem S Lim, Soren Gantt, John Kinuthia, Dara A Lehman, Jennifer Slyker, Dalton Wamalwa","doi":"10.1136/bmjgh-2024-015841","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Historically, children who are HIV-exposed, uninfected (CHEU) have been found to have greater morbidity and mortality than children who are HIV-unexposed, uninfected (CHUU). To assess whether this difference persists in the era of universal antiretroviral therapy (ART), we conducted a cohort study to compare the risk of acute diarrhoea, respiratory tract infections (RTI), malaria, hospitalisation, and all-cause mortality between Kenyan CHEU and CHUU from birth to 2 years.</p><p><strong>Methods: </strong>From December 2018 to March 2020 at Mathare North Health Centre in Nairobi, we recruited pregnant women living with HIV on ART for ≥6 months and pregnant women without HIV from the same community. We followed the mother-infant pairs for 2 years post partum and collected data on symptoms of illness, clinical visits and diagnoses, and infant feeding every 3 months; a self-selected subset of participants also received weekly data collection for up to 1 year. We compared the risk of each outcome between CHEU versus CHUU using HRs from Andersen-Gill (recurrent morbidity outcomes) and Cox proportional hazards (mortality) regression models adjusted for maternal age, marital status and education level.</p><p><strong>Results: </strong>Among 187 mother-infant pairs with postpartum data, 86 (46%) infants were CHEU and 101 (54%) were CHUU. All initiated breastfeeding, and 88% of CHEU and 57% of CHUU were exclusively breastfed (EBF) for ≥6 months. There was no significant difference in risk of diarrhoea (HR=0.79, 95% CI 0.52 to 1.22), malaria (HR=0.44, 95% CI 0.16 to 1.21), hospitalisation (HR=1.11, 95% CI 0.30 to 4.14), or mortality (HR=1.87, 95% CI 0.17 to 20.5). However, CHEU had lower risk of any RTI (HR=0.60, 95% CI 0.44 to 0.82) and pneumonia (HR=0.29, 95% CI 0.091 to 0.89).</p><p><strong>Conclusions: </strong>CHEU born to women on effective long-term ART experienced similar overall morbidity and mortality as CHUU. However, CHEU had substantially lower risk of pneumonia and other RTI, possibly due to longer EBF in this group.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 1","pages":""},"PeriodicalIF":7.1000,"publicationDate":"2025-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11748780/pdf/","citationCount":"0","resultStr":"{\"title\":\"The Linda Kizazi study: a comparison of morbidity and mortality from birth to 2 years between children who are HIV-unexposed and HIV-exposed, uninfected in the era of universal antiretroviral therapy.\",\"authors\":\"Emily R Begnel, Ednah Ojee, Judy Adhiambo, Eliza Mabele, Brenda Wandika, Vincent Ogweno, Efrem S Lim, Soren Gantt, John Kinuthia, Dara A Lehman, Jennifer Slyker, Dalton Wamalwa\",\"doi\":\"10.1136/bmjgh-2024-015841\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Historically, children who are HIV-exposed, uninfected (CHEU) have been found to have greater morbidity and mortality than children who are HIV-unexposed, uninfected (CHUU). To assess whether this difference persists in the era of universal antiretroviral therapy (ART), we conducted a cohort study to compare the risk of acute diarrhoea, respiratory tract infections (RTI), malaria, hospitalisation, and all-cause mortality between Kenyan CHEU and CHUU from birth to 2 years.</p><p><strong>Methods: </strong>From December 2018 to March 2020 at Mathare North Health Centre in Nairobi, we recruited pregnant women living with HIV on ART for ≥6 months and pregnant women without HIV from the same community. We followed the mother-infant pairs for 2 years post partum and collected data on symptoms of illness, clinical visits and diagnoses, and infant feeding every 3 months; a self-selected subset of participants also received weekly data collection for up to 1 year. We compared the risk of each outcome between CHEU versus CHUU using HRs from Andersen-Gill (recurrent morbidity outcomes) and Cox proportional hazards (mortality) regression models adjusted for maternal age, marital status and education level.</p><p><strong>Results: </strong>Among 187 mother-infant pairs with postpartum data, 86 (46%) infants were CHEU and 101 (54%) were CHUU. All initiated breastfeeding, and 88% of CHEU and 57% of CHUU were exclusively breastfed (EBF) for ≥6 months. There was no significant difference in risk of diarrhoea (HR=0.79, 95% CI 0.52 to 1.22), malaria (HR=0.44, 95% CI 0.16 to 1.21), hospitalisation (HR=1.11, 95% CI 0.30 to 4.14), or mortality (HR=1.87, 95% CI 0.17 to 20.5). However, CHEU had lower risk of any RTI (HR=0.60, 95% CI 0.44 to 0.82) and pneumonia (HR=0.29, 95% CI 0.091 to 0.89).</p><p><strong>Conclusions: </strong>CHEU born to women on effective long-term ART experienced similar overall morbidity and mortality as CHUU. However, CHEU had substantially lower risk of pneumonia and other RTI, possibly due to longer EBF in this group.</p>\",\"PeriodicalId\":9137,\"journal\":{\"name\":\"BMJ Global Health\",\"volume\":\"10 1\",\"pages\":\"\"},\"PeriodicalIF\":7.1000,\"publicationDate\":\"2025-01-19\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11748780/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"BMJ Global Health\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1136/bmjgh-2024-015841\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"BMJ Global Health","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1136/bmjgh-2024-015841","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH","Score":null,"Total":0}
引用次数: 0
摘要
背景：历史上，发现艾滋病毒暴露，未感染（CHEU）的儿童比未暴露，未感染（CHUU）的儿童有更高的发病率和死亡率。为了评估这种差异在普遍抗逆转录病毒治疗（ART）时代是否仍然存在，我们进行了一项队列研究，比较肯尼亚CHEU和CHUU从出生到2岁的急性腹泻、呼吸道感染（RTI）、疟疾、住院和全因死亡率的风险。方法：2018年12月至2020年3月，我们在内罗毕Mathare North卫生中心招募了来自同一社区接受抗逆转录病毒治疗≥6个月的艾滋病毒感染孕妇和未感染艾滋病毒的孕妇。我们在产后对母婴进行了2年的随访，收集了有关疾病症状、临床就诊和诊断以及每3个月一次的婴儿喂养的数据；自我选择的参与者子集也接受了长达1年的每周数据收集。我们使用Andersen-Gill（复发性发病率结局）和Cox比例风险（死亡率）回归模型的hr对CHEU和CHUU之间的每个结局的风险进行了比较，这些回归模型调整了产妇年龄、婚姻状况和教育水平。结果：187对有产后资料的母婴中，86例（46%）为CHEU， 101例（54%）为CHUU。所有人都开始母乳喂养，88%的CHUU和57%的CHUU是纯母乳喂养(EBF)≥6个月。腹泻（风险比=0.79,95% CI 0.52至1.22）、疟疾（风险比=0.44,95% CI 0.16至1.21）、住院（风险比=1.11,95% CI 0.30至4.14）或死亡率（风险比=1.87,95% CI 0.17至20.5）的风险无显著差异。然而，CHEU的任何呼吸道感染（HR=0.60, 95% CI 0.44 ~ 0.82）和肺炎（HR=0.29, 95% CI 0.091 ~ 0.89）的风险较低。结论：接受有效长期抗逆转录病毒治疗的妇女所生的chu与chu的总体发病率和死亡率相似。然而，CHEU的肺炎和其他RTI风险明显较低，可能是由于该组EBF较长。
The Linda Kizazi study: a comparison of morbidity and mortality from birth to 2 years between children who are HIV-unexposed and HIV-exposed, uninfected in the era of universal antiretroviral therapy.
Background: Historically, children who are HIV-exposed, uninfected (CHEU) have been found to have greater morbidity and mortality than children who are HIV-unexposed, uninfected (CHUU). To assess whether this difference persists in the era of universal antiretroviral therapy (ART), we conducted a cohort study to compare the risk of acute diarrhoea, respiratory tract infections (RTI), malaria, hospitalisation, and all-cause mortality between Kenyan CHEU and CHUU from birth to 2 years.
Methods: From December 2018 to March 2020 at Mathare North Health Centre in Nairobi, we recruited pregnant women living with HIV on ART for ≥6 months and pregnant women without HIV from the same community. We followed the mother-infant pairs for 2 years post partum and collected data on symptoms of illness, clinical visits and diagnoses, and infant feeding every 3 months; a self-selected subset of participants also received weekly data collection for up to 1 year. We compared the risk of each outcome between CHEU versus CHUU using HRs from Andersen-Gill (recurrent morbidity outcomes) and Cox proportional hazards (mortality) regression models adjusted for maternal age, marital status and education level.
Results: Among 187 mother-infant pairs with postpartum data, 86 (46%) infants were CHEU and 101 (54%) were CHUU. All initiated breastfeeding, and 88% of CHEU and 57% of CHUU were exclusively breastfed (EBF) for ≥6 months. There was no significant difference in risk of diarrhoea (HR=0.79, 95% CI 0.52 to 1.22), malaria (HR=0.44, 95% CI 0.16 to 1.21), hospitalisation (HR=1.11, 95% CI 0.30 to 4.14), or mortality (HR=1.87, 95% CI 0.17 to 20.5). However, CHEU had lower risk of any RTI (HR=0.60, 95% CI 0.44 to 0.82) and pneumonia (HR=0.29, 95% CI 0.091 to 0.89).
Conclusions: CHEU born to women on effective long-term ART experienced similar overall morbidity and mortality as CHUU. However, CHEU had substantially lower risk of pneumonia and other RTI, possibly due to longer EBF in this group.
期刊介绍：
BMJ Global Health is an online Open Access journal from BMJ that focuses on publishing high-quality peer-reviewed content pertinent to individuals engaged in global health, including policy makers, funders, researchers, clinicians, and frontline healthcare workers. The journal encompasses all facets of global health, with a special emphasis on submissions addressing underfunded areas such as non-communicable diseases (NCDs). It welcomes research across all study phases and designs, from study protocols to phase I trials to meta-analyses, including small or specialized studies. The journal also encourages opinionated discussions on controversial topics.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
