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孕妇在怀孕和婴儿神经发育期间使用整合酶链转移抑制剂

Paige L Williams^1,2, Martha Boahene¹, Lisa E Mash³

¹Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.

JAMA network open

|November 26, 2025

概括

在怀孕期间暴露于整合酶链转移抑制剂 (INSTIs) 的婴儿的神经发育得分与暴露于蛋白酶抑制剂 (PI) 的婴儿相似. 然而,得分低于暴露于非核酸逆转录酶抑制剂 (NNRTI) 的婴儿,特别是如果ART开始于受孕后.

科学领域:

产前艾滋病毒研究产前艾滋病毒研究
婴儿神经发育的结果
抗逆转录病毒治疗 (ART) 的安全性

背景情况:

目前的指导方针建议综合酶链转移抑制剂 (INSTIs) 用于围产期艾滋病毒治疗.
关于INSTIs关于婴儿神经发育的安全性的数据有限.

研究的目的:

为了比较在子宫内暴露于基于INSTI的ART疗法和基于PI或NNRTI的疗法的婴儿的神经发育结果.
评估ART时间对神经发育结果的影响.

主要方法:

在22个美国学术中心进行前性队列研究 (2012-2023).
包括1006名暴露于艾滋病毒的未感染婴儿,这些婴儿在1岁时使用贝利婴幼儿发育量表 (Bayley-III) 进行评估.
比较认知,语言和运动领域的得分,调整混因素并按ART启动时间分层.

主要成果:

在暴露于基于INSTI和基于PI的ART疗程的婴儿之间没有发现显著的神经发育差异.
与NNRTI暴露的婴儿相比,暴露于INSTI的婴儿在认知,语言和运动领域的平均得分略低一些.
这些差异在怀孕后发生母体ART启动时更加明显.

结论:

婴儿神经发育结果在基于INSTI和基于PI的ART疗法之间是可比的.
虽然暴露于INSTI的婴儿的得分略低于暴露于NNRTI的婴儿,但认知得分仍然接近人口标准.
研究结果支持继续在艾滋病毒感染的孕妇的第一线ART中使用INSTIs.

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