Birth size and early pneumonia predict linear growth among HIV‐exposed uninfected infants

Abstract

Stunting remains a global health priority, particularly in sub‐Saharan Africa. Identifying determinants of linear growth in HIV‐exposed uninfected (HEU) infants can inform interventions to prevent stunting in this vulnerable population. HIV‐infected mothers and their uninfected infants were followed monthly from pregnancy to 12‐month post‐partum in Nairobi, Kenya. Mixed‐effects models estimated the change in length‐for‐age z‐score (LAZ) from birth to 12 months by environmental, maternal, and infant characteristics. Multivariable models included factors univariately associated with LAZ. Among 372 HEU infants, mean LAZ decreased from −0.54 (95% confidence interval [CI] [−0.67, −0.41]) to −1.09 (95% CI [−1.23, −0.96]) between 0 and 12 months. Declines in LAZ were associated with crowding (≥2 persons per room; adjusted difference [AD] in 0–12 month change: −0.46; 95% CI [−0.87, −0.05]), use of a pit latrine versus a flush toilet (AD: −0.29; 95% CI [−0.57, −0.02]), and early infant pneumonia (AD: −1.14; 95% CI [−1.99, −0.29]). Infants with low birthweight (<2,500 g; AD: 1.08; 95% CI [0.40, 1.76]) and birth stunting (AD: 1.11; 95% CI [0.45, 1.78]) experienced improved linear growth. By 12 months of age, 46 infants were stunted, of whom 11 (24%) were stunted at birth. Of the 34 infants stunted at birth with an available 12‐month LAZ, 68% were not stunted at 12 months. Some low birthweight and birth‐stunted HEU infants had significant linear growth recovery. Early infant pneumonia and household environment predicted poor linear growth and may identify a subgroup of HEU infants for whom to provide growth‐promoting interventions.

Prevalence, feeding practices, and factors associated with undernutrition among HIV-exposed uninfected children aged 6 to 18 months in Bushenyi district, western Uganda: A cross-sectional study

“…However, Nduta & Marnane did not nd any relationship between history of low birth weight and undernutrition [42]. It is known that some infants who are born small (low birthweight or short length) experience signi cant growth recovery by the end of the rst year of life [43]. In this current study, most participants were younger than one year of age, which may have in uenced the outcome.…”

Examining the relationship between diarrhea and linear growth in Kenyan HIV-exposed, uninfected infants

“… 1 Data summary was previously presented elsewhere [ 35 ] 2 Percents may not add to 100% due to missing data …”

Defective monocyte enzymatic function and an inhibitory immune phenotype in HIV-exposed uninfected African infants in the era of anti-retroviral therapy

“…HIV and hCMV are immunomodulatory viruses 81 , so co-exposure to these two pathogens in early life may contribute to this immune dysregulation. We postulate that the complexity, variable severity and/or persistence of this immunological phenotype explain the variable clinical manifestations reported in HEU infants 8,9,11,40,[82][83][84][85][86] , which may depend on the duration and intensity of exposure to HIV and other infectious co-factors.…”