| BackgroundDespite years of efforts to prevent mother-to-child transmission(MTCT)of HIV,many neonates are still infected with HIV by MTCT.HIV infection can cause changes in related laboratory indexes through immunosuppression and chronic inflammatory response;the application of antiretroviral drugs may cause the occurrence of liver function,blood lipid and hematology abnormalities.The influencing factors are complicated.At present,domestic and foreign studies on the changes of relevant laboratory indexes after antiretroviral therapy are mostly concentrated on older HIV-infected children.Due to the particularity of the population,the complexity of antiretroviral therapy,the difficulty of obtaining samples,and the difficulty of management,there are few relevant domestic and foreign studies on HIV-infected or HIV-exposed infants.Objective1 To investigate the changes of main laboratory indexes and preditors in HIV-infected infants after initiating first-line antiretroviral therapy in China;2 To investigate the changes of main laboratory indexes in HIV-exposed neonates after receiving of prophylactic triple antiretroviral drugs.Methods1 The changes of main laboratory indexes in HIV-infected infants after first-line antiretroviral therapy:A retrospective cohort study was conducted All HIV-infected infants who met the inclusion criteria reported in China’s HIV/AIDS Comprehensive Response Information Management System between January,2011 and December,2018 were included in this study.The results of liver function(aspartate aminotransferase,alanine aminotransferase),blood lipid(total cholesterol,triglyceride)and hematology(white blood cell,hemoglobin,platelets)laboratory indexes were collected.Rank sum test and chi-square test were used to describe the changes of laboratory indexes at baseline and 12 months after initiating first-line antiretroviral therapy,and univariate and multivariate logistic regression models were used to analyze the predictors.2 The changes of main laboratory indexes in HIV-exposed neonates after receiving of prophylactic triple antiretroviral drugs:A retrospective cohort study was conducted.The counties and districts in Yunnan,Sichuan,Guangdong,Guangxi Zhuang Autonomous Region and Xinjiang Uygur Autonomous Region with a high number of HIV infected pregnant women were selected as the study sites.All HIV-exposed neonates whose HIV-infected mothers did not receive effective drug intervention during pregnancy and who met the inclusion criteria from December 2015 to December 2019 were included in this study.The results of liver function(aspartate aminotransferase,alanine aminotransferase),blood lipid(total cholesterol,triglyceride)and hematology(white blood cell,hemoglobin)laboratory indexes were collected.Rank sum test and chi-square test were used to describe the changes of laboratory indexes at 2,4 and 6 weeks after birth.Results1 The changes of main laboratory indexes in HIV-infected infants after first-line antiretroviral therapy:A total of 259 subjects were included in the analysis.The proportionss of aspartate aminotransferase,alanine aminotransferase,total cholesterol,triglyceride,hemoglobin,platelets and white blood cell abnormalities before antiretroviral therapy were 38.46%,25.10%,9.52%,46.94%,43.65%,7.94%and 0.00%,respectively;and the proportions of abnormalities were 8.10%,4.45%,53.06%,48.03%,14.29%,1.19%and 0.00%after 12 months of antiretroviral therapy,respectively.The changes trend of liver function,blood lipid and hematology laboratory indexes level were consistent with the changes of abnormal proportions.There was a degree of liver function abnormalities at baseline,and at the age of less than 1 and weight-for-age Z-score≥-2 at baseline were more likely to have hepatic function abnormalities at baseline.The proportions of liver function abnormalities was significantly improved after 12 months of antiretroviral therapy,and the use of abacavir+lamivudine+(lopinavir/ritonavir or nevirapine)],viral load>1000 copies/mL after 12 months of antiretroviral therapy and height-for-age Z-score ≥-2 at baseline were more likely to have liver function abnormalities.There was a degree of triglyceride abnormality at baseline,and the proportions of total cholesterol abnormlity increased significantly after 12 months of antiretroviral therapy.Lopinavir/ritonavir-containing regimen,viral load≤1000 copies/mL after 12 months of antiretroviral therapy and height-for-age Z-score<-2 at baseline were more likely to have dyslipidemia after 12 months of antiretroviral therapy.There were some abnormalities in baseline hematology,and moderate and severe immunosuppression and weight-for-age Z-score<-2 at baseline were were more likely to have hematological abnormalities at baseline.Hematological abnormalities improved significantly after 12 months of antiretroviral therapy.2 The changes of main laboratory indexes in HIV-exposed neonates after receiving of prophylactic triple antiretroviral drugs:A total of 100 subjects were included in the analysis.The proportionss of aspartate aminotransferase,alanine aminotransferase,total cholesterol,triglyceride,white blood cell and platelets abnormalities were 0.00%,9.89%,10.00%,14.00%,0.00%and 2.02%in the first 2 weeks of life,respectively.The proportionss of abnormalities were 6.59%,10.00%,20.00%,32.00%,0.00%,63.54%in the first 6 weeks of life,respectively;and the proportionss of triglyceride and hemoglobin bnormalities increased significantly compared with 2 weeks.Only 1 neonate with ≥3 Grade alanine aminotransferase abnormality and 12 neonates with ≥3 Grade hemoglobin abnormality were found at six weeks after birth.There were no statistical differences in other laboratory indexes.The changes trend of liver function,blood lipid and hematology laboratory indexes level were consistent with the changes of abnormal proportions basically.Conclusion1 There is a certain degree of liver function,blood lipid and hematology abnormalities in HIV-infected infants.The proportions of liver function and hematology abnormalities were significantly improved after antiretroviral therapy,which were considered to be largely influenced by viral suppression after antiretroviral drugs;while dyslipidemia was not improved after initiating antiretroviral therapy,which were considered to be largely influenced by drugs.It is suggested to to regularly monitor blood lipid after antiretroviral therapy,especially for infants with poor growth and development and using Lopinavir/ritonavir-containing regimen,so as to timely detect dyslipidemia.2 Through 2 weeks of prophylactic triple antiretroviral drugs to use in HIV-exposed neonates,the proportions of liver function abnormalities were 0～10%,blood lipid abnormalities were 10～14%,and hematology abnormalities were 0～2%.The proportions of triglyceride and hemoglobin abnormalities were significantly increased in the first 6 weeks of life,compared with 2 weeks.These are not exempt from the effects of drugs.It is suggested to pay special attention to the level of blood lipid and hemoglobin after receiving of prophylactic triple antiretroviral drugs in HIV-exposed neonates. |
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