Comparing growth velocity of HIV exposed and non-exposed infants: An observational study of infants enrolled in a randomized control trial in Zambia

Abstract

Background Impaired growth among infants remains one of the leading nutrition problems globally. In this study, we aimed to compare the growth trajectory rate and evaluate growth trajectory characteristics among children, who are HIV exposed uninfected (HEU) and HIV unexposed uninfected (HUU), under two years in Zambia. Method Our study used data from the ROVAS II study (PACTR201804003096919), an open-label randomized control trial of two verses three doses of live, attenuated, oral RotarixTM administered 6 &10 weeks or at 6 &10 weeks plus an additional dose at 9 months of age, conducted at George clinic in Lusaka, Zambia. Anthropometric measurements (height and weight) were collected on all scheduled and unscheduled visits. We defined linear growth velocity as the rate of change in height and estimated linear growth velocity as the first derivative of the mixed effect model with fractional polynomial transformations and, thereafter, used the second derivative test to determine the peak height and age at peak heigh. Results We included 212 infants in this study with median age 6 (IQR: 6–6) weeks of age. Of these 97 (45.3%) were female, 35 (16.4%) were stunted, and 59 (27.6%) were exposed to HIV at baseline. Growth velocity was consistently below the 3rd percentile of the WHO linear growth standard for HEU and HUU children. The peak height and age at peak height among HEU children were 74.7 cm (95% CI = 73.9–75.5) and 15.5 months (95% CI = 14.7–16.3) respectively and those for HUU were 73 cm (95% CI = 72.1–74.0) and 15.6 months (95% CI = 14.5–16.6) respectively. Conclusion We found no difference in growth trajectories between infants who are HEU and HUU. However, the data suggests that poor linear growth is universal and profound in this cohort and may have already occurred in utero.

Maternal breastfeeding and education impact infant growth and development more than in-utero HIV/antiretroviral therapy exposure in context of universal antiretroviral therapy

“…We found no statistically significant difference in WAZ, HAZ, and WHZ in HEU compared with HUU children. Our findings are consistent with a study from Zambia [22] but differ from other studies in Nigeria [19], Malawi and Uganda [20], and Kenya [18], which found that HEU children had lower WAZ, HAZ, and WHZ. A study in Botswana also observed a higher risk of stunting in HEU than in HUU children [7].…”

“…A study in Botswana also observed a higher risk of stunting in HEU than in HUU children [7]. Most of these studies demonstrating growth deficits in HEU used data collected at or before 2014 (when Option B+ was rolled out) [18–20,22]. Our study and the study in Zambia [22] that found no difference in growth between HEU and HUU children both used data after 2017.…”

“…Most of these studies demonstrating growth deficits in HEU used data collected at or before 2014 (when Option Bþ was rolled out) [18][19][20]22]. Our study and the study in Zambia [22] that found no difference in growth between Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved. Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.…”

“…Together, these studies suggest that exposure to both HIV and ART in utero may affect infants' growth. However, evidence regarding growth deficits in HEU has been conflicting -with some studies noting no differences between HEU and HUU [4,22]. Similarly, while some studies showed poor language development in HEU [15], others found no differences in neurodevelopment delay between HEU and HUU [23].…”

Growth patterns of infants with in- utero HIV and ARV exposure in Cape Town, South Africa and Lusaka, Zambia

“…All covariates in univariable analyses with a p -value of 0.10 were included in multivariable analyses. Additionally, an a priori decision was made to include maternal age in the multivariable model, regardless of univariable p-value [ 3 , 32 , 33 ]. Infant feeding practice was defined as exclusive breastfeeding, formula feeding, or mixed feeding based on maternal report.…”