Dataset Information

Impact of HIV and antiretroviral drug exposure on lung growth and function over 2 years in an African Birth Cohort.

ABSTRACT:

Objective

To assess the impact of HIV and antiretroviral exposure without infection on lung growth and function over the first 2 years of life.

Design

Prospective observational study of an African birth cohort, Drakenstein Child Health Study.

Method

Infants enrolled antenatally had lung function measured at 6 weeks, 1 and 2 years. HIV-infected women received antiretroviral therapy (ART) as per local guidelines. The association between HIV and antiretroviral exposure with lung function was assessed using mixed effects modelling.

Results

Of 1143 infants born, two HIV-infected infants were excluded from analysis; 909 (80%) infants had lung function collected at 6 weeks [190 (21%) were HIV-exposed uninfected (HEU)]; 782 (69%) at 1 year and 741 (65%) at 2 years. At 6 weeks HEU infants had larger tidal volume compared with HIV-unexposed infants (1.13?ml, confidence interval: 0.02-2.23, P?=?0.045). High maternal viral load was associated with a 17% lower expiratory flow over 2 years (0.17, confidence interval 0.00-0.34, P?=?0.046). First-line ART initiated during pregnancy was associated with lower infant tidal volume at 6 weeks compared with those who initiated ART before pregnancy (-2.7?ml, -5.31 to -0.10, P?=?0.042), and low maternal CD4 cell counts associated with lower infant tidal over 2 years (-11.1?ml, -18.58-3.58, P?=?0.004).

Conclusion

HIV exposure is associated with altered lung function in early life, with a vulnerable HEU subgroup based on maternal disease severity, immunological compromise and ART exposure. These data highlight the importance of ongoing surveillance of respiratory health in HEU children.

SUBMITTER: Gray DM

PROVIDER: S-EPMC7050792 | biostudies-literature | 2020 Mar

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Impact of HIV and antiretroviral drug exposure on lung growth and function over 2 years in an African Birth Cohort.

Gray Diane M DM Wedderburn Catherine J CJ MacGinty Rae P RP McMillan Lauren L Jacobs Carvern C Stadler Jacob A M JAM Hall Graham L GL Zar Heather J HJ

AIDS (London, England) 20200301 4

<h4>Objective</h4>To assess the impact of HIV and antiretroviral exposure without infection on lung growth and function over the first 2 years of life.<h4>Design</h4>Prospective observational study of an African birth cohort, Drakenstein Child Health Study.<h4>Method</h4>Infants enrolled antenatally had lung function measured at 6 weeks, 1 and 2 years. HIV-infected women received antiretroviral therapy (ART) as per local guidelines. The association between HIV and antiretroviral exposure with lu ...[more]

PMID: 31714357

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Project description:IntroductionThere is a growing population of children who are HIV-exposed and uninfected (HEU) with the successful expansion of antiretroviral therapy (ART) use in pregnancy. Children who are HEU are at risk of delayed neurodevelopment; however, there is limited research on early brain growth and maturation. We aimed to investigate the effects of in utero exposure to HIV/ART on brain structure of infants who are HEU compared to HIV-unexposed (HU).MethodsMagnetic resonance imaging using a T2-weighted sequence was undertaken in a subgroup of infants aged 2-6 weeks enrolled in the Drakenstein Child Health Study birth cohort, South Africa, between 2012 and 2015. Mother-child pairs received antenatal and postnatal HIV testing and ART per local guidelines. We compared subcortical and total grey matter volumes between HEU and HU groups using multivariable linear regression adjusting for infant age, sex, intracranial volume and socio-economic variables. We further assessed associations between brain volumes with maternal CD4 cell count and ART exposure.ResultsOne hundred forty-six infants (40 HEU; 106 HU) with high-resolution images were included in this analysis (mean age 3 weeks; 50.7% male). All infants who were HEU were exposed to ART (88% maternal triple ART). Infants who were HEU had smaller caudate volumes bilaterally (5.4% reduction, p < 0.05) compared to HU infants. There were no group differences in other subcortical volumes (all p > 0.2). Total grey matter volume was also reduced in infants who were HEU (2.1% reduction, p < 0.05). Exploratory analyses showed that low maternal CD4 cell count (<350 cells/mm3 ) was associated with decreased infant grey matter volumes. There was no relationship between timing of ART exposure and grey matter volumes.ConclusionsLower caudate and total grey matter volumes were found in infants who were HEU compared to HU in the first weeks of life, and maternal immunosuppression was associated with reduced volumes. These findings suggest that antenatal HIV exposure may impact early structural brain development and improved antenatal HIV management may have the potential to optimize neurodevelopmental outcomes of children who are HEU.

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Dataset Information

Impact of HIV and antiretroviral drug exposure on lung growth and function over 2 years in an African Birth Cohort.

Objective

Design

Method

Results

Conclusion

Publications

Impact of HIV and antiretroviral drug exposure on lung growth and function over 2 years in an African Birth Cohort.

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