Fetal, neonatal, and infant death among offspring of pregnant women with HIV in Tanzania.

IF 3.4 2区 医学 Q3 IMMUNOLOGY AIDS Pub Date : 2024-11-15 Epub Date: 2024-07-30 DOI:10.1097/QAD.0000000000003985
Karim P Manji, Alfa Muhihi, Christopher P Duggan, Fadhlun M Alwy Al-Beity, Nandita Perumal, Nzovu Ulenga, Wafaie W Fawzi, Christopher R Sudfeld
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Abstract

Objective: Assess the risk of death for offspring of pregnant women with HIV (PWHIV) and the association with sociodemographic, pregnancy, HIV-related, and birth factors.

Design: We conducted a prospective cohort study of PWHIV on antiretroviral therapy (ART) and their offspring in urban Tanzania who were enrolled in a vitamin D trial conducted from June 2015 to October 2019.

Methods: We described rates of fetal, neonatal, and infant death and assessed risk factors for these outcomes with generalized estimating equations. We also estimated population-attributable risk percentages for the contribution of prematurity and small-for-gestational age (SGA) to neonatal and infant mortality.

Results: Among 2299 PWHIV, there were a total of 136 fetal deaths (5.6%) and the stillbirth rate was 42.0 per 1000 total births. Among 2167 livebirths, there were 57 neonatal deaths (26.3 per 1000 livebirths) and 114 infant deaths (52.6 per 1000 livebirths). Twin birth was associated with neonatal death, while maternal CD4 + T-cell count <350 cells/μl in pregnancy was associated with infant death ( P -values < 0.05). As compared to term-appropriate-for-gestational age (AGA) births, the relative risks for neonatal mortality for term-SGA, preterm-AGA, and preterm-SGA infants were 2.07 [95% confidence interval (CI): 1.00-4.28], 2.87 (95% CI 1.54-5.35), and 7.15 (95% CI: 2.11-24.30), respectively. We estimated that 42.7% of neonatal and 29.4% of infant deaths were attributable to prematurity and SGA in the cohort.

Conclusions: The risk of death is high for offspring of PWHIV in Tanzania and the combination of prematurity and fetal growth restriction may account for nearly half of neonatal deaths.

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坦桑尼亚感染艾滋病毒的孕妇后代中的胎儿、新生儿和婴儿死亡情况。
目的评估感染艾滋病毒的孕妇(PWLHIV)后代的死亡风险以及与社会人口学、妊娠、艾滋病毒相关因素和出生因素的关联:我们对坦桑尼亚城市中接受抗逆转录病毒疗法(ART)的感染艾滋病病毒的孕妇(PWLHIV)及其后代进行了前瞻性队列研究,这些孕妇参加了 2015 年 6 月至 2019 年 10 月进行的维生素 D 试验:我们描述了胎儿、新生儿和婴儿的死亡率,并使用广义估计方程评估了这些结果的风险因素。我们还估算了早产和小于胎龄(SGA)对新生儿和婴儿死亡率的人口可归因风险百分比:在 2,299 名艾滋病毒携带者中,共有 136 例胎儿死亡(5.6%),死胎率为每千名新生儿 42.0 例。在 2 167 例活产中,有 57 例新生儿死亡(每 1 000 例活产中有 26.3 例)和 114 例婴儿死亡(每 1 000 例活产中有 52.6 例)。双胎与新生儿死亡有关,而母体 CD4 T 细胞计数与新生儿死亡有关:坦桑尼亚艾滋病毒携带者后代的死亡风险很高,早产和胎儿生长受限可能是近一半新生儿死亡的原因。
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来源期刊
AIDS
AIDS 医学-病毒学
CiteScore
5.90
自引率
5.30%
发文量
478
审稿时长
3 months
期刊介绍: ​​​​​​​​​​​​​​​​​Publishing the very latest ground breaking research on HIV and AIDS. Read by all the top clinicians and researchers, AIDS has the highest impact of all AIDS-related journals. With 18 issues per year, AIDS guarantees the authoritative presentation of significant advances. The Editors, themselves noted international experts who know the demands of your work, are committed to making AIDS the most distinguished and innovative journal in the field. Submitted articles undergo a preliminary review by the editor. Some articles may be returned to authors without further consideration. Those being considered for publication will undergo further assessment and peer-review by the editors and those invited to do so from a reviewer pool.
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