The University of Zimbabwe College of Health Sciences (UZ-CHS) BIRTH COHORT study: rationale, design and methods.

Autor: Duri K; Department of Immunology, University of Zimbabwe College of Health Sciences (UZ-CHS), P.O. Box A178 Avondale, Harare, Zimbabwe. kduri@medsch.uz.ac.zw., Gumbo FZ; Department of Paediatrics and Child Health, UZ-CHS, Harare, Zimbabwe., Munjoma PT; Department of Immunology, University of Zimbabwe College of Health Sciences (UZ-CHS), P.O. Box A178 Avondale, Harare, Zimbabwe., Chandiwana P; UZ-CHS Research Support Centre, UZ-CHS, Harare, Zimbabwe., Mhandire K; Department of Chemical Pathology, UZ-CHS, Harare, Zimbabwe., Ziruma A; Department of Obstetrics and Gynaecology, UZ-CHS, Harare, Zimbabwe., Macpherson A; Clinic for Visceral Surgery and Medicine, Inselspital Bern and Bern University, Bern, Switzerland., Rusakaniko S; Department of Community Medicine, UZ-CHS, Harare, Zimbabwe., Gomo E; UZ-CHS Research Support Centre, UZ-CHS, Harare, Zimbabwe.; Department of Medical Laboratory Sciences, UZ-CHS, Harare, Zimbabwe., Misselwitz B; Clinic for Visceral Surgery and Medicine, Inselspital Bern and Bern University, Bern, Switzerland., Mazengera LR; Department of Immunology, University of Zimbabwe College of Health Sciences (UZ-CHS), P.O. Box A178 Avondale, Harare, Zimbabwe.
Jazyk: angličtina
Zdroj: BMC infectious diseases [BMC Infect Dis] 2020 Oct 02; Vol. 20 (1), pp. 725. Date of Electronic Publication: 2020 Oct 02.
DOI: 10.1186/s12879-020-05432-6
Abstrakt: Background: Commencing lifelong antiretroviral therapy (ART) immediately following HIV diagnosis (Option B+), has greatly improved maternal-infant health. Thus, large and increasing numbers of HIV-infected women are on ART during pregnancy, a situation concurrently increasing numbers of HIV-exposed-uninfected (HEU) infants. Compared to their HIV-unexposed-uninfected (HUU) counterparts, HEU infants show higher rates of adverse birth outcomes, mortality, infectious/non-communicable diseases including impaired growth and neurocognitive development. There is an urgent need to understand the impact of HIV and early life ART exposures, immune-metabolic dysregulation, comorbidities and environmental confounders on adverse paediatric outcomes.
Methods: Six hundred (600) HIV-infected and 600 HIV-uninfected pregnant women ≥20 weeks of gestation will be enrolled from four primary health centres in high density residential areas of Harare. Participants will be followed up as mother-infant-pairs at delivery, week(s) 1, 6, 10, 14, 24, 36, 48, 72 and 96 after birth. Clinical, socio-economic, nutritional and environmental data will be assessed for adverse birth outcomes, impaired growth, immune/neurodevelopment, vertical transmission of HIV, hepatitis-B/C viruses, cytomegalovirus and syphilis. Maternal urine, stool, plasma, cord blood, amniotic fluid, placenta and milk including infant plasma, dried blood spot and stool will be collected at enrolment and follow-up visits. The composite primary endpoint is stillbirth and infant mortality within the first two years of life in HEU versus HUU infants. Maternal mortality in HIV-infected versus -uninfected women is another primary outcome. Secondary endpoints include a range of maternal and infant outcomes. Sub-studies will address maternal stress and malnutrition, maternal-infant latent tuberculosis, Helicobacter pylori infections, immune-metabolomic dysregulation including gut, breast milk and amniotic fluid dysbiosis.
Discussion: The University of Zimbabwe-College of Health-Sciences-Birth-Cohort study will provide a comprehensive assessment of risk factors and biomarkers for HEU infants' adverse outcomes. This will ultimately help developing strategies to mitigate effects of maternal HIV, early-life ART exposures and comorbidities on infants' mortality and morbidity.
Trial Registration: ClinicalTrial.gov Identifier: NCT04087239 . Registered 12 September 2019.
Databáze: MEDLINE
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