Background and Methods . Differences in newborn outcome measures for human immunodeficiency virus (HIV)-1-infected and HIV-1-exposed but uninfected infants have been found in several studies, but not in others. Eighty-four infected and 248 uninfected children born to HIV-1-seropositive mothers followed prospectively in a multicenter, perinatal HIV-1 transmission cohort study were compared for differences in maternal demographics, health status, and newborn outcome measures, including delivery complications, physical examination findings, neonatal complications, and laboratory results.Results . Mothers of HIV-1-infected infants were more likely than those of uninfected infants to have acquired immunodeficiency syndrome (AIDS) diagnosed through 2 weeks postpartum (21% vs 11%, P = .04); the transmission rate for the 38 women with AIDS was 37% compared with 22% for the 245 women without AIDS. Two of 27 (7%) women receiving zidovudine during pregnancy had infected infants compared with 73 (27%) of 275 women who did not receive zidovudine ( P = .033). Mean gestational age was significantly lower among HIV-1-infected (37 weeks) than among uninfected infants (38 weeks; P .001). Infected infants had significantly higher rates of prematurity (gestational age less than 37 weeks) (33% vs 19%, P = .01) and extreme prematurity (gestational age less than 34 weeks) (18% vs 6%, P = .001) than uninfected infants. Infection was associated with lower birth weight (2533 g vs 2862 g, P .001) and smaller head circumference (32.0 cm vs 33.1 cm, P = .001). HIV-1-infected infants were significantly more likely to be small for gestational age (26% vs 16%, P = .04) and low birth weight (less than 2500 g) (45% vs 29%, P = .006) than infants who were uninfected. Twenty-two (26%) HIV-1-infected children died during a median follow-up of 27.6 months (range 1.9 to 98.3 months). Prematurity was predictive of survival: by Kaplan-Meier, an estimated 55% (95% confidence interval, 31% to 72%) of preterm infected children survived to 24 months compared with 84% (95% confidence interval, 70% to 92%) of full-term infected children ( P = .005).Conclusion . Infants born to women with AIDS are at higher risk for HIV-1 infection than are infants born to HIV-1-infected women with AIDS not yet diagnosed. Women receiving zidovudine appear less likely to transmit HIV-1 to their infants. Significantly higher rates of prematurity and intrauterine growth retardation were found among HIV-1-infected infants than among those in the uninfected, HIV-1-exposed control group. Prematurity was associated with shortened survival in HIV-1-infected infants. Measures of intrauterine growth and gestation appear to be important predictors of HIV-1 infection status for seropositive infants and of prognosis for the infected infant.
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机译：背景与方法。在几项研究中发现了人类免疫缺陷病毒（HIV）-1感染和暴露于HIV-1但未感染的婴儿的新生儿结局指标的差异，但在其他研究中却没有发现。在多中心围产期HIV-1传播队列研究中对前瞻性随访的HIV-1血清阳性母亲所生的84名感染儿童和248名未感染儿童进行了比较，以比较孕产妇的人口统计学，健康状况和新生儿结局指标（包括分娩并发症，身体状况）的差异。检查结果，新生儿并发症和实验室检查结果。感染HIV-1的婴儿的母亲比未感染的婴儿的母亲在产后2周内被诊断出患有免疫缺陷综合症（AIDS）的可能性更高（21％比11％，P = .04）。 38例艾滋病患者的传播率为37％，而245例AIDS患者的传播率为22％。怀孕期间接受齐多夫定的27名妇女中有2名（7％）的婴儿受到感染，而未接受齐多夫定的275名妇女中有73名（27％）（P = .033）。 HIV-1感染者（37周）的平均胎龄明显低于未感染婴儿（38周; P <0.001）。被感染的婴儿的早产率（胎龄小于37周）（33％比19％，P = .01）和极端早产（胎龄小于34周）（18％vs 6％，P = .001）显着更高。 ）比未感染的婴儿。感染与出生体重降低（2533 g vs 2862 g，P <.001）和头围较小（32.0 cm vs 33.1 cm，P = .001）相关。感染HIV-1的婴儿的胎龄明显较小（26％vs 16％，P = .04）和低出生体重（小于2500 g）（45％vs 29％，P = .006）比未感染的婴儿要多。在中位随访27.6个月（1.9到98.3个月）期间，有22名（26％）感染HIV-1的儿童死亡。早产可预测生存：Kaplan-Meier估计，有55％（95％置信区间，从31％到72％）的早产儿存活到24个月，而84％（95％置信区间，从70％到92％） ）的足月感染儿童（P = 0.005）。结论。与尚未被诊断为HIV-1感染的患有AIDS的妇女所生的婴儿相比，患有AIDS的妇女生育的婴儿具有更高的HIV-1感染风险。接受齐多夫定的妇女似乎不太可能将HIV-1传播给婴儿。与未感染HIV-1的对照组相比，感染HIV-1的婴儿的早产和宫内发育迟缓的比率明显更高。早产与HIV-1感染婴儿的生存期缩短有关。宫内生长和妊娠的测量指标似乎是血清阳性婴儿HIV-1感染状况和感染婴儿预后的重要预测指标。
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