Higher prevalence of stunting and poor growth outcomes in HIV-exposed uninfected than HIV-unexposed infants in Kenya

Abstract Background Despite the recognized benefit of antiretroviral therapy (ART) for preventing and treating HIV, some studies have reported adverse birth outcomes with in utero ART exposure. We evaluated the effect of infant in utero HIV and ART exposure on preterm delivery (PTD), low birth weight (LBW), small for gestational age (SGA), and underweight for age (UFA) at 6 weeks. Methods We surveyed 6179 HIV-unexposed-uninfected (HUU) and 2599 HIV-exposed-uninfected (HEU) infants. HEU infants were stratified into 3 groups: ART, Zidovudine alone, and no antiretrovirals (None). The ART group was further stratified to explore pre- or postconception exposure. Multivariable logistic regression evaluated effects of HIV and ARV exposure on the outcomes. Results We found higher odds of PTD, LBW, SGA, and UFA in HEU than HUU infants. HEU in the None group (adjusted odds ratio [AOR], 1.9; 95% confidence interval [CI], 1.2–3.0) or those whose mothers initiated ART preconception (AOR, 1.7; 95% CI, 1.1–2.5) had almost twice the odds of PTD than infants whose mothers started ART postconception, but no increased odds for other outcomes. Conclusions There was an association between preconception ART and PTD. As ART access increases, pregnancy registers or similar surveillance should be in place to monitor outcomes to inform future policy.

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Maternal Tenofovir Disoproxil Fumarate Use in Pregnancy and Growth Outcomes among HIV-Exposed Uninfected Infants in Kenya

Infectious Diseases in Obstetrics and Gynecology ◽

10.1155/2015/276851 ◽

2015 ◽

Vol 2015 ◽

pp. 1-9 ◽

Cited By ~ 10

Author(s):

Jillian Pintye ◽

Agnes Langat ◽

Benson Singa ◽

John Kinuthia ◽

Beryne Odeny ◽

...

Keyword(s):

Tenofovir Disoproxil Fumarate ◽

Self Report ◽

Linear Regression Models ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Growth Outcomes ◽

Preexposure Prophylaxis ◽

Hiv Exposed ◽

Relationship Of ◽

Exposed Uninfected

Background. Tenofovir disoproxil fumarate (TDF) is commonly used in antiretroviral treatment (ART) and preexposure prophylaxis regimens. We evaluated the relationship of prenatal TDF use and growth outcomes among Kenyan HIV-exposed uninfected (HEU) infants.Materials and Methods.We included PCR-confirmed HEU infants enrolled in a cross-sectional survey of mother-infant pairs conducted between July and December 2013 in Kenya. Maternal ART regimen during pregnancy was determined by self-report and clinic records. Six-week and 9-monthz-scores for weight-for-age (WAZ), weight-for-length (WLZ), length-for-age (LAZ), and head circumference-for-age (HCAZ) were compared among HEU infants with and without TDF exposure usingt-tests and multivariate linear regression models.Results.Among 277 mothers who received ART during pregnancy, 63% initiated ART before pregnancy, of which 89 (32%) used TDF. No differences in birth weight (3.0 kg versus 3.1 kg,p=0.21) or gestational age (38 weeks versus 38 weeks,p=0.16) were detected between TDF-exposed and TDF-unexposed infants. At 6 weeks, unadjusted mean WAZ was lower among TDF-exposed infants (−0.8 versus −0.4,p=0.03), with a trend towards association in adjusted analyses (p=0.06). There were no associations between prenatal TDF use and WLZ, LAZ, and HCAZ in 6-week or 9-month infant cohorts.Conclusion.Maternal TDF use did not adversely affect infant growth compared to other regimens.

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Cytomegalovirus viraemia is associated with poor growth and T-cell activation with an increased burden in HIV-exposed uninfected infants

AIDS ◽

10.1097/qad.0000000000001568 ◽

2017 ◽

Vol 31 (13) ◽

pp. 1809-1818 ◽

Cited By ~ 9

Author(s):

Miguel A. Garcia-Knight ◽

Eunice Nduati ◽

Amin S. Hassan ◽

Irene Nkumama ◽

Timothy J. Etyang ◽

...

Keyword(s):

T Cell ◽

T Cell Activation ◽

Cell Activation ◽

Poor Growth ◽

Hiv Exposed ◽

Exposed Uninfected

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Maternal HIV infection and other factors associated with growth outcomes of HIV-uninfected infants in Entebbe, Uganda

Public Health Nutrition ◽

10.1017/s1368980013000499 ◽

2013 ◽

Vol 16 (9) ◽

pp. 1548-1557 ◽

Cited By ~ 29

Author(s):

Lawrence Muhangi ◽

Swaib A Lule ◽

Harriet Mpairwe ◽

Juliet Ndibazza ◽

Moses Kizza ◽

...

Keyword(s):

Hiv Infection ◽

Maternal Education ◽

Hiv Transmission ◽

Growth Data ◽

Poor Growth ◽

Growth Outcomes ◽

Maternal Hiv ◽

Maternal Hiv Infection ◽

Hiv Exposed ◽

Living Children

AbstractObjectiveTo assess the associations between maternal HIV infection and growth outcomes of HIV-exposed but uninfected infants and to identify other predictors for poor growth among this population.DesignWithin a trial of de-worming during pregnancy, the cohort of offspring was followed from birth. HIV status of the mothers and their children was investigated and growth data for children were obtained at age 1 year. Length-for-age, weight-for-age and weight-for-length Z-scores were calculated for each child; Z-scores <−2 were defined as stunting, underweight and wasting, respectively.SettingThe study was conducted in Entebbe municipality and Katabi sub-county, Uganda.SubjectsThe sample consisted of 1502 children aged 1 year: HIV-unexposed (n 1380) and HIV-exposed not infected (n 122).ResultsPrevalence of stunting, underweight and wasting was 14·2 %, 8·0 % and 3·9 %, respectively. There was evidence for an association between maternal HIV infection and odds of being underweight (adjusted OR = 2·32; 95 % CI 1·32, 4·09; P = 0·006) but no evidence for an association with stunting or with wasting. Young maternal age, low maternal education, low birth weight, early weaning and experiencing a higher number of episodes of malaria during infancy were independent predictors for stunting and underweight. A higher number of living children in the family was associated with wasting.ConclusionsMaternal HIV infection was associated with being underweight in HIV-exposed uninfected infants. The success of programmes for prevention of mother-to-child HIV transmission means that an increasing number of infants will be born to HIV-infected women without acquiring HIV. Therefore, viable nutritional interventions need to be identified for this population.

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Longitudinal Follow-Up of Blood Telomere Length in HIV-Exposed Uninfected Children Having Received One Year of Lopinavir/Ritonavir or Lamivudine as Prophylaxis

Children ◽

10.3390/children8090796 ◽

2021 ◽

Vol 8 (9) ◽

pp. 796

Author(s):

Audrey Monnin ◽

Amélie Vizeneux ◽

Nicolas Nagot ◽

Sabrina Eymard-Duvernay ◽

Nicolas Meda ◽

...

Keyword(s):

Telomere Length ◽

Quantitative Polymerase Chain Reaction ◽

Safety Data ◽

Poor Growth ◽

Telomere Shortening ◽

Motor Abilities ◽

Hiv Exposed ◽

One Year ◽

Hiv Acquisition ◽

Exposed Uninfected

Telomere shortening can be enhanced upon human immunodeficiency virus (HIV) infection and by antiretroviral (ARV) exposures. The aim of this study was to evaluate the acute and long-term effect on telomere shortening of two ARV prophylaxes, lopinavir/ritonavir (LPV/r) and lamivudine (3TC), administered to children who are HIV-exposed uninfected (CHEU) to prevent HIV acquisition through breastfeeding during the first year of life, and to investigate the relationship between telomere shortening and health outcomes at six years of age. We included 198 CHEU and measured telomere length at seven days of life, at week-50 and at six years (year-6) using quantitative polymerase chain reaction. At week-50, telomere shortening was observed among 44.3% of CHEU, irrespective of the prophylactic treatment. Furthermore, this telomere shortening was neither associated with poor growth indicators nor neuropsychological outcomes at year-6, except for motor abilities (MABC test n = 127, β = −3.61, 95%CI: −7.08, −0.14; p = 0.04). Safety data on telomere shortening for infant HIV prophylaxis are scarce. Its association with reduced motor abilities deserves further attention among CHEU but also HIV-infected children receiving ARV treatment.

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Safety of tenofovir during pregnancy: early growth outcomes and hematologic side effects in HIV-exposed uninfected infants

European Journal of Pediatrics ◽

10.1007/s00431-019-03481-x ◽

2019 ◽

Vol 179 (1) ◽

pp. 99-109 ◽

Cited By ~ 3

Author(s):

Vera Seidel ◽

Katharina Weizsäcker ◽

Wolfgang Henrich ◽

Rebecca C. Rancourt ◽

Christoph Bührer ◽

...

Keyword(s):

Side Effects ◽

Early Growth ◽

Growth Outcomes ◽

Hiv Exposed ◽

Exposed Uninfected

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Growth and Neurodevelopment of HIV-Exposed Uninfected Children: a Conceptual Framework

Current HIV/AIDS Reports ◽

10.1007/s11904-019-00459-0 ◽

2019 ◽

Vol 16 (6) ◽

pp. 501-513 ◽

Cited By ~ 10

Author(s):

Catherine J. Wedderburn ◽

Ceri Evans ◽

Shunmay Yeung ◽

Diana M. Gibb ◽

Kirsten A. Donald ◽

...

Keyword(s):

Risk Factors ◽

Conceptual Framework ◽

Intervention Strategies ◽

Research Gaps ◽

Poor Growth ◽

Middle Income ◽

Middle Income Countries ◽

Poor Outcomes ◽

Hiv Exposed ◽

Exposed Uninfected

Abstract Purpose of Review The population of HIV-exposed uninfected (HEU) children is expanding rapidly, and over one million HEU infants are born each year globally. Several recent studies have reported that HEU children, particularly in low- and middle-income countries, are at risk of poor outcomes, including impaired growth and neurodevelopment. However, the reasons for poor clinical outcomes amongst HEU children remain unclear. Recent Findings We summarise the findings from recent large studies that have characterised growth and neurodevelopment in HEU children, identified risk factors and explored underlying mechanistic pathways. We propose a conceptual framework to explain how exposure to HIV and antiretroviral therapy (ART) may lead to adverse growth and neurodevelopment in uninfected children, and review the available evidence and research gaps. Summary We propose that HEU children are affected both indirectly, through the augmentation of universal risk factors underlying poor growth and neurodevelopment, and directly through HIV/ART-specific pathways, which ultimately may converge through a series of common pathogenic mechanisms. In the era of universal ART, a better understanding of these pathways is crucial to inform future prevention and intervention strategies.

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