HIV Infection, Viral Load, Low Birth Weight, and Nevirapine Are Independent Influences on Growth Velocity in HIV-Exposed South African Infants

Ramokolo, Vundli; Lombard, Carl; Fadnes, Lars Thore; Doherty, Tanya; Jackson, Debra; Goga, Ameena; Chhagan, Meera; Broeck, Jan Van den

doi:10.3945/jn.113.178616

Cited by 28 publications

(40 citation statements)

References 25 publications

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“…While inferior growth patterns have been reported in several studies, these studies differ from our design in that all not HIV-EU participated in PMTCT care until the time of growth measurement [16,32,33] and/or that weaning was considerably earlier in HIV-EU [32,33]. In agreement with our findings, other studies with continued PMTCT-like follow-up [34,35] and similar feeding practice [34] found non-inferior growth in HIV-EU infants.…”

Section: Discussionsupporting

confidence: 82%

Growth pattern in Ethiopian infants – the impact of exposure to maternal HIV infection in relation to socio-economic factors

Walles

Balcha

Winqvist

et al. 2017

Global Health Action

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Background: Infants exposed to maternal HIV infection who remain HIV-uninfected (HIV-exposed/uninfected; HIV-EU) may be at increased risk of growth retardation, which could be due both to directly HIV-related effects and to socio-economic factors overrepresented among HIV-positive women.Objective: To investigate growth development at 9–12 months of age in HIV-EU infants participating in prevention of mother-to-child transmission (PMTCT) care compared to HIV unexposed (HIV-U) infants in relation to socio-economic conditions.Methods: Anthropometric and socio-economic data were collected retrospectively from PMTCT registers (for HIV-EU infants), with HIV-U controls recruited at measles vaccination at public health facilities in Ethiopia. Growth was compared with regard to HIV exposure and socio-economic variables in multivariate regression analysis.Results: The following growth measurements were found for 302 HIV-EU and 358 HIV-U infants at 9–12 months of age, respectively: mean weight-for-age z-score (WAZ) 0.04 and −0.21, p < 0.001 (proportion underweight 5.7% and 6.7%, p = 0.60); median length-for-age z-score (LAZ) −0.92 and −0.91, p = 0.53 (proportion stunted 25.1% and 20.5%, p = 0.17). In multivariate analysis, lower WAZ was associated with male sex (p = 0.021), lower maternal education (p < 0.001), presence of siblings (p < 0.01) and HIV-U (p < 0.01). Underweight was associated with male sex (p = 0.017) and absence of maternal education (p = 0.019). Lower LAZ was associated with male sex (p < 0.001), presence of siblings (p < 0.001) and poor maternal education (p < 0.01), while stunting was associated with male sex (p < 0.001), presence of siblings (p < 0.001), few rooms in the home (p < 0.01), access to running water (p = 0.026) and low level of maternal education (p = 0.014).Conclusions: At 9–12 months of age, HIV-EU infants had non-inferior growth and higher mean WAZ than HIV-U controls. Poor growth development was associated with socio-economic factors. This suggests health benefits from PMTCT participation for infant growth. Similar interventions could be considered for Ethiopian infants, irrespective of HIV exposure, with a particular focus on children with poor socio-economic status.

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Section: Discussionsupporting

confidence: 82%

Growth pattern in Ethiopian infants – the impact of exposure to maternal HIV infection in relation to socio-economic factors

Walles

Balcha

Winqvist

et al. 2017

Global Health Action

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“…Thirty‐seven reports, from 29 studies conducted in 12 African countries and involving 32 173 (11 164 HEU) children, were included, as shown in Figure (characteristics of and reasons for the exclusion of studies are shown in Appendix S5; characteristics of included studies are shown in Appendix S6). Three studies contributed data on the same outcome at different time points (mortality , neurodevelopment and growth , respectively); while five studies contributed two reports each, on different outcomes . Overall, 28 prospective studies were included , of which 11 were randomised controlled trials (13 reports), and two interventional cohort studies (four reports) focusing on PMTCT .…”

Section: Resultsmentioning

confidence: 99%

“…Since 2015, WHO recommends universal ART for all HIV‐infected individuals, irrespective of disease stage, and in line with this, ‘Option B+’ as the preferred PMTCT strategy . Effective use of maternal ART results in viral suppression with subsequent immune restoration and protection of maternal health ; HEU infants born to mothers with lower HIV viral load and/or higher CD4 count are at significantly lower risks of death , hospitalisation , severe infection , immune dysfunction and growth faltering than those born to women with untreated or advanced HIV disease .…”

Section: Introductionmentioning

confidence: 99%

Clinical outcomes of HIV‐exposed, HIV‐uninfected children in sub‐Saharan Africa

Roux

Abrams

Nguyen

et al. 2016

Tropical Med Int Health

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Abstractobjective HIV-exposed but HIV-uninfected (HEU) children are widely considered at increased risk of mortality and morbidity. Recent advances in prevention of mother-to-child HIV transmission (PMTCT) strategies, incorporating life-long universal maternal antiretroviral therapy (ART, "Option B+") with extended breastfeeding, may improve HEU child health substantially. We critically reviewed reports of mortality/morbidity among HEU and HIV-unexposed (HU) children in sub-Saharan Africa.methods We searched Medline, EMBASE, CINAHL, PsycINFO, Academic Search Premier, Global Health & Psychosocial Instruments databases, conference abstracts, and reference lists for longitudinal studies from sub-Saharan Africa reporting mortality and clinical morbidity among HIVuninfected children aged ≤10 years, by maternal HIV status. Studies were appraised by NewcastleOttawa Scale and ACROBAT-NRSI. Due to substantial heterogeneity of study designs, populations and results (I 2 = 75%), data were not synthesised.results We included 37 reports (28 studies, 11 164 HEU children); methodological and reporting quality were variable. Most reports came from settings without universal access to maternal ART (n = 35). Results were conflicting, with some studies indicating increased risk of mortality, hospitalisation and/or under-nutrition among HEU children, while others found no evidence of increased risk. In subanalyses, improved maternal health, ART use and breastfeeding were strongly protective for all outcomes. Only 39% (11/28) of studies adjusted for major confounders. Reports from settings using universal maternal ART with breastfeeding (n = 2) found no differences in growth or development but did not report mortality or infectious morbidity.conclusions The existing literature provides little insight into HEU child health under recently adopted PMTCT strategies. There is a need for robust comparative data on HEU and HIV-unexposed child health outcomes under Option B+; optimising breastfeeding practices and increasing maternal use of ART should be urgent public health priorities.

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“…Furthermore, we did not have information on the HIV status of the infant at birth which has been shown to be associated with SGA and preterm delivery. 28, 29 However, both maternal HIV severity and fetal HIV acquisition might be intermediates on the pathway between ARV exposure and SGA, in which case adjusting for them in the analyses would require advanced methods and more granular information of the intermediates. 30 Also, greater than 30% pregnancies had missing information on illicit drug and alcohol use, both of which are major risk factors for SGA and may be important confounders of the association between exposure to ARVs and SGA.…”

Section: Discussionmentioning

confidence: 99%

Antiretroviral Therapy Use During Pregnancy and the Risk of Small for Gestational Age Birth in a Medicaid Population

Phiri¹,

Williams

Dugan³

et al. 2015

Pediatric Infectious Disease Journal

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Background Several studies have assessed the association between antiretroviral (ARV) therapy use during pregnancy and small for gestational age (SGA), but the evidence remains incompletely elucidated. Methods We linked data from Tennessee Medicaid files and vital records to evaluate pregnancies among human immunodeficiency virus (HIV)-infected women who delivered between 1994 and 2009.Maternal HIV status was defined based on diagnosis codes, ARV prescriptions, and laboratory codes for CD4 count or HIV RNA assays. ARV use was identified from pharmacy claims. Risk of SGA (defined as birthweight below the 10th percentile for gestational age) and preterm birth were evaluated using logistic regression models. Results 477 HIV- infected pregnant women contributing 604 singleton pregnancies were identified; 156 (26%) delivered SGA infants. ARV use during pregnancy was not associated with SGA (adjusted odds ratio [aOR] = 0.93; 95% confidence interval [CI], 0.56-1.56) or preterm birth (aOR = 0.74; 95% CI, 0.42-1.32). Exposure to a protease inhibitor (PI) during the first trimester was associated with a lower risk of SGA (OR, 0.54; 95% CI, 0.29-1.01) compared to non-exposure to a PI throughout pregnancy. Conclusions We observed no evidence of an association between ARV exposure during pregnancy and SGA delivery in this Medicaid cohort of HIV-infected women.

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HIV Infection, Viral Load, Low Birth Weight, and Nevirapine Are Independent Influences on Growth Velocity in HIV-Exposed South African Infants

Cited by 28 publications

References 25 publications

Growth pattern in Ethiopian infants – the impact of exposure to maternal HIV infection in relation to socio-economic factors

Growth pattern in Ethiopian infants – the impact of exposure to maternal HIV infection in relation to socio-economic factors

Clinical outcomes of HIV‐exposed, HIV‐uninfected children in sub‐Saharan Africa

Antiretroviral Therapy Use During Pregnancy and the Risk of Small for Gestational Age Birth in a Medicaid Population

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