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In utero exposure to antiretroviral therapy: feasibility of long-term follow-up

机译：子宫内接受抗逆转录病毒治疗：长期随访的可行性

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Most uninfected children born to diagnosed HIV-infected women in the United Kingdom (UK) are exposed to antiretroviral therapy (ART) in utero and neonatally, and concerns exist about potential adverse effects of such exposure. We explored the feasibility of using national clinic-based follow-up to investigate the association between ART exposure and adverse health events occurring after the neonatal period. Active surveillance of obstetric and paediatric HIV infection is conducted through the National Study of HIV in Pregnancy and Childhood (NSHPC). Between 2002 and 2005, health professionals enrolled previously notified uninfected children in a consented follow-up study (the CHildren exposed to AntiRetroviral Therapy (CHART) study). Follow-up information was collected opportunistically using a standard questionnaire. Of 2104 eligible uninfected children born in the UK between 1996 and 2004, 704 (33.5%) were enrolled in CHART; parents of 4.8% (100/2104) declined, 2.8% (59/2104) had gone abroad, 21.6% (455/2104) were not contactable, and the remaining 37.3% (786/2104) were not enrolled mainly because of lack of clinic resources or unwillingness of health professionals to approach the families. Demographic characteristics and type of ART exposure for enrolled and non-enrolled children were similar. Latest information on enrolled children was available at a median age of 24 months. Minor childhood ailments were reported in the majority of children, febrile seizures in 1.6% (11/704), and major health problems in 3.8% (27/704). It was reassuring that prevalence of these outcomes was within UK norms, but numbers were small and duration of follow-up was limited. The difficulties encountered in enrolling and retaining children in this study indicate that comprehensive clinic-based follow-up of ART-exposed uninfected children is not practical. Alternative approaches are required; a robust, secure data linkage protocol would provide a more feasible and sustainable system for long-term monitoring of in utero ART exposure.
机译：在英国（UK），大多数由确诊为HIV感染的妇女所生的未感染儿童在子宫内和新生儿都接受抗逆转录病毒治疗（ART），因此人们担心这种暴露可能产生不利影响。我们探讨了使用基于国家临床随访的方法调查ART暴露与新生儿期后发生的不良健康事件之间的关联的可行性。通过全国妊娠和儿童艾滋病毒研究（NSHPC）对产科和儿科HIV感染进行了主动监测。在2002年至2005年之间，卫生专业人员在同意的随访研究（接受抗逆转录病毒疗法（CHART）研究的儿童）中纳入了先前通知未感染儿童的信息。使用标准调查表时机收集后续信息。在1996年至2004年期间，在英国出生的2104名合格未感染儿童中，有704名（33.5％）加入了CHART;父母（4.8％（100/2104））下降了，有2.8％（59/2104）出国了，21.6％（455/2104）无法联系，剩余的37.3％（786/2104）因为缺乏诊所资源不足或卫生专业人员不愿与家人接触。入组和未入组儿童的人口统计学特征和ART暴露类型相似。有关已入组儿童的最新信息，年龄中位数为24个月。据报道，大多数儿童中有较小的儿童疾病，高热惊厥占1.6％（11/704），主要健康问题占3.8％（27/704）。可以放心的是，这些结局的患病率在英国规范范围内，但数量很少，随访时间有限。在这项研究中招收和留住儿童时遇到的困难表明，对基于ART的未感染儿童进行全面的基于临床的随访是不切实际的。需要替代方法;健壮，安全的数据链接协议将为子宫内ART暴露的长期监测提供更可行和可持续的系统。

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