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ABSTRACT: Background
Effects of prolonged nevirapine prophylaxis exposure on growth among HIV-exposed uninfected (HEU) infants are unknown. This study examines the impact of extended nevirapine prophylaxis from 6 weeks to 6 months on the growth of HEU infants followed for 18 months and also identifies correlates of incident wasting, stunting, underweight, and low head circumference in the HPTN 046 trial.Methods
Intention-to-treat analysis examined the effect of extended nevirapine exposure on: weight-for-age Z-score, length-for-age Z-score, weight-for-length Z-score, and head circumference-for-age Z-score. Multivariable linear mixed-effects and Cox proportional hazard models were used to compare growth outcomes between the study arms and identify correlates of incident adverse growth outcomes, respectively.Results
Compared to placebo, extended prophylactic nevirapine given daily from 6 weeks to 6 months did not affect growth in HEU breastfeeding (BF) infants over time (treatment × time: P > 0.05). However, overall growth declined over time (time effect: P < 0.01) when compared with WHO general population norms. Male sex was associated with higher risk of all adverse growth outcomes (P < 0.05), whereas short BF duration was associated with wasting (P = 0.03). Maternal antiretroviral therapy exposure was protective against underweight (P = 0.02). Zimbabwe tended to have worse growth outcomes especially stunting, compared to South Africa, Uganda and Tanzania (P < 0.05).Conclusions
It is reassuring that prolonged exposure to nevirapine for prevention-of-mother-to-child HIV transmission does not restrict growth. However, targeted interventions are needed to improve growth outcomes among at-risk HEU infants (i.e., male sex, short BF duration, lack of maternal antiretroviral therapy exposure, and resident in Zimbabwe).
SUBMITTER: Onyango-Makumbi C
PROVIDER: S-EPMC6817404 | biostudies-literature | 2019 Dec
REPOSITORIES: biostudies-literature
Onyango-Makumbi Carolyne C Owora Arthur H AH Mwiru Ramadhani S RS Mwatha Anthony A Young Alicia M AM Moodley Dhayendre D Coovadia Hoosen M HM Stranix-Chibanda Lynda L Manji Karim K Maldonado Yvonne Y Richardson Paul P Andrew Philip P George Kathleen K Fawzi Wafaie W Fowler Mary Glenn MG
Journal of acquired immune deficiency syndromes (1999) 20191201 4
<h4>Background</h4>Effects of prolonged nevirapine prophylaxis exposure on growth among HIV-exposed uninfected (HEU) infants are unknown. This study examines the impact of extended nevirapine prophylaxis from 6 weeks to 6 months on the growth of HEU infants followed for 18 months and also identifies correlates of incident wasting, stunting, underweight, and low head circumference in the HPTN 046 trial.<h4>Methods</h4>Intention-to-treat analysis examined the effect of extended nevirapine exposure ...[more]