Dataset Information

Growth Trajectories of HIV Exposed and HIV Unexposed Infants. A Prospective Study in Gweru, Zimbabwe.

ABSTRACT:

Background

With the increasing HIV seroprevalence among women of childbearing age in sub-Saharan Africa, limited data on growth outcomes of HIV exposed infants under current policies of universal maternal antiretroviral therapy exist.

Methods

The longitudinal growth patterns of 114 HIV exposed and unexposed infants were assessed and compared. The prevalence and factors associated with malnutrition were established. Infants under prevention of mother to child transmission care were recruited at 6?weeks post-delivery as were their HIV unexposed counterparts. Weight and length measurements were recorded at birth, 6 and 16?weeks postpartum.

Results

HIV vertical transmission rate was 8.8%. HIV exposed infants had significantly lower mean birth weights compared to HIV unexposed infants (2.9?±?0.3; 3.2?±?0.5; P?z-scores for HIV exposed, uninfected (HEU) infants were significantly below those of the HIV unexposed infants during follow up. By 6?weeks of age, 28.5% of HEU infants were malnourished while no malnutrition was evident in HIV unexposed infants. A gestational age <37?weeks (OR: 3.83; 95% CI: 1.03-14.30; P?=?.045) and HIV exposure (OR: 1.62; 95% CI: 0.17-15.73; P?=?.017) substantially increased the risk of stunting.

Conclusion

Growth deficits were witnessed in HIV exposed infants compared to HIV unexposed infants. There is need for early nutritional monitoring and support among HIV exposed infants.

SUBMITTER: Mabaya L

PROVIDER: S-EPMC7868486 | biostudies-literature | 2021

REPOSITORIES: biostudies-literature

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Publications

Growth Trajectories of HIV Exposed and HIV Unexposed Infants. A Prospective Study in Gweru, Zimbabwe.

Mabaya Lucy L Matarira Hilda Tendisa HT Tanyanyiwa Donald Moshen DM Musarurwa Cuthbert C Mukwembi Johannes J

Global pediatric health 20210204

<h4>Background</h4>With the increasing HIV seroprevalence among women of childbearing age in sub-Saharan Africa, limited data on growth outcomes of HIV exposed infants under current policies of universal maternal antiretroviral therapy exist.<h4>Methods</h4>The longitudinal growth patterns of 114 HIV exposed and unexposed infants were assessed and compared. The prevalence and factors associated with malnutrition were established. Infants under prevention of mother to child transmission care were ...[more]

PMID: 33614842

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Project description:BackgroundMaternal HIV and antiretroviral therapy (ART) exposure in utero may influence infant weight, but the contribution of maternal y body mass index (BMI) to early life overweight and obesity is not clear.ObjectiveTo estimate associations between maternal BMI at entry to antenatal care (ANC) and infant weight through approximately 1 year of age and to evaluate whether associations were modified by maternal HIV status, maternal HIV and viral load, breastfeeding intensity through 6 months or timing of entry into ANC.MethodsWe followed HIV-uninfected and -infected pregnant women initiating efavirenz-based ART from first antenatal visit through 12 months postpartum. Infant weight was assessed via World Health Organization BMI and weight-for-length z-scores (WLZ) at 6 weeks, 3, 6, 9 and 12 months. We used multivariable linear mixed-effects models to estimate associations between maternal BMI and infant z-scores over time.ResultsIn 861 HIV-uninfected infants (454 HIV-exposed; 407 HIV-unexposed), nearly 20% of infants were overweight or obese by 12 months of age, regardless of HIV exposure status. In multivariable analyses, increasing maternal BMI category was positively associated with higher infant BMIZ and WLZ scores between 6 weeks and 12 months of age and did not differ by HIV exposure status. However, HIV-exposed infants had slightly lower BMIZ and WLZ trajectories through 12 months of age, compared with HIV-unexposed infants across all maternal BMI categories. Differences in BMIZ and WLZ scores by HIV exposure were not explained by timing of entry into ANC or maternal viral load pre-ART initiation, but z-scores were slightly higher for HIV-exposed infants who were predominantly or exclusively versus partially breastfed.ConclusionsThese findings suggest maternal BMI influences early infant weight gain, regardless of infant HIV exposure status. Intervention to reduce maternal BMI may help to address growing concerns about obesity among HIV-uninfected children.

Project description:BACKGROUND:Lifelong antiretroviral therapy (ART) reduces mother-to-child HIV transmission (MTCT) and improves maternal health. Data on the outcomes of HIV-exposed infants (HEI) compared to their unexposed counterparts in the era of universal ART is limited. We compared birth and 6-week outcomes among infants born to HIV-positive and HIV-negative women in Lesotho. METHODS:941 HIV-negative and 653 HIV-positive pregnant women were enrolled in an observational cohort to evaluate the effectiveness of prevention of mother-to-child HIV transmission (PMTCT) program after implementation of universal maternal ART in 14 health facilities. Pregnancy, delivery, birth, and 6-week data were collected through participant interviews and medical record review. DNA PCR testing for HEI was conducted within 2 weeks of birth and at around 6 weeks of age. Data were analysed to estimate the distribution of birth outcomes, mortality, HIV transmission and HIV-free survival at 6 weeks. RESULTS:HIV-positive women were older (mean age of 28.7 vs. 24.4 years) and presented for antenatal care earlier (mean gestational age of 23.0 weeks vs 25.3 weeks) than HIV-negative women. Prematurity was more frequent among HEI, 7.8% vs. 3.6%. There was no difference in rates of congenital anomalies between HEI (1.0%) and HIV-unexposed infants (HUI) (0.6%). Cumulative HIV transmission was 0.9% (N = 4/431) (95% CI:0.25-2.36) at birth and 1.0% (N = 6/583) (95% CI:0.38-2.23) at 6 weeks. Overall mortality, including stillbirths, was 5.2% and 6.0% by 6 weeks for HUI and HEI respectively. Among liveborn infants, 6-week HIV-free survival for HEI was 95.6% (95% CI:93.7-97.1) compared to 96.8% (95% CI:95.4-97.9) survival for HUI. CONCLUSIONS:Implementation of universal maternal ART lowers MTCT at 6 weeks of age with no differences in congenital anomalies or early mortality between HIV exposed Infants and HIV unexposed infants. However, HIV exposed infants continue to have high rates of prematurity despite improved maternal health on ART.

Project description:BackgroundThe period of complementary feeding, starting around 6 months of age, is a time of high risk for growth faltering and morbidity. Low micronutrient density of locally available foods is a common problem in low income countries. Children of HIV-infected women are especially vulnerable. Although antiretroviral prophylaxis can reduce breast milk HIV transmission in early infancy, there are no clear feeding guidelines for after 6 months. There is a need for acceptable, feasible, affordable, sustainable and safe (AFASS by WHO terminology) foods for both HIV-exposed and unexposed children after 6 months of age.Methods and findingsWe conducted in Lusaka, Zambia, a randomised double-blind trial of two locally made infant foods: porridges made of flour composed of maize, beans, bambaranuts and groundnuts. One flour contained a basal and the other a rich level of micronutrient fortification. Infants (n = 743) aged 6 months were randomised to receive either regime for 12 months. The primary outcome was stunting (length-for-age Z<-2) at age 18 months. No significant differences were seen between trial arms overall in proportion stunted at 18 months (adjusted odds ratio 0.87; 95% CI 0.50, 1.53; P = 0.63), mean length-for-age Z score, or rate of hospital referral or death. Among children of HIV-infected mothers who breastfed <6 months (53% of HIV-infected mothers), the richly-fortified porridge increased length-for-age and reduced stunting (adjusted odds ratio 0.17; 95% CI 0.04, 0.84; P = 0.03). Rich fortification improved iron status at 18 months as measured by hemoglobin, ferritin and serum transferrin receptors.ConclusionsIn the whole study population, the rich micronutrient fortification did not reduce stunting or hospital referral but did improve iron status and reduce anemia. Importantly, in the infants of HIV-infected mothers who stopped breastfeeding before 6 months, the rich fortification improved linear growth. Provision of such fortified foods may benefit health of these high risk infants.Trial registrationControlled-Trials.com ISRCTN37460449.

Dataset Information

Growth Trajectories of HIV Exposed and HIV Unexposed Infants. A Prospective Study in Gweru, Zimbabwe.

Background

Methods

Results

Conclusion

Publications

Growth Trajectories of HIV Exposed and HIV Unexposed Infants. A Prospective Study in Gweru, Zimbabwe.

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