How do maternal HIV infection and the early nutritional environment influence the development of infants exposed to HIV in utero?

AbstractMalnutrition and infectious disease often coexist in socially inequitable contexts. Malnutrition in the perinatal period adversely affects offspring development and lifelong non-communicable disease risk. Less is known about the effects of infectious disease exposure during critical windows of development and health, and links between in utero HIV-exposure in the absence of neonatal infection, perinatal nutritional environments, and infant development are poorly defined. In a pilot feasibility study at Kalafong Hospital, Pretoria, South Africa, we aimed to better understand relationships between maternal HIV infection and the early nutritional environment of in utero HIV exposed uninfected (HEU) infants. We also undertook exploratory analyses to investigate relationships between food insecurity and infant development. Mother-infant dyads were recruited after delivery and followed until 12 weeks postpartum. Household food insecurity, nutrient intakes and dietary diversity scores did not differ between mothers living with or without HIV. Maternal reports of food insecurity were associated with lower maternal nutrient intakes 12 weeks postpartum, and in infants, higher brain-to-body weight ratio at birth and 12 weeks of age, and attainment of fewer large movement and play activities milestones at 12 weeks of age, irrespective of maternal HIV status. Reports of worry about food runout were associated with increased risk of stunting for HEU, but not unexposed, uninfected infants. Our findings suggest that food insecurity, in a vulnerable population, adversely affects maternal nutritional status and infant development. In utero exposure to HIV may further perpetuate these effects, which has implications for early child development and lifelong human capital.

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in utero HIV exposure and the early nutritional environment influence neurodevelopment in infants before age three: findings from an evidenced review and meta-analysis.

10.1101/2020.08.27.20182774 ◽

2020 ◽

Author(s):

Marina White ◽

Kristin L Connor

Keyword(s):

Hiv Infection ◽

Early Life ◽

Meta Analysis ◽

In Utero ◽

Nutrition Interventions ◽

Neurodevelopmental Outcomes ◽

Maternal Hiv ◽

Nutritional Environment ◽

Maternal Hiv Infection ◽

Hiv Exposure

The developing brain is especially vulnerable to infection and suboptimal nutrition during the pre- and early postnatal periods. Exposure to maternal HIV infection and antiretroviral therapies (ART) in utero and during breastfeeding can adversely influence infant (neuro)developmental trajectories. How early life nutrition may be optimised to improve neurodevelopmental outcomes for infants who are HIV/ART-exposed has not been well characterised. We conducted an up-to-date evidence review and meta-analysis on the influence of HIV exposure in utero and during breastfeeding, and early life nutrition, on infant neurodevelopmental outcomes before age three. We report that exposure to maternal HIV infection/ART may adversely influence expressive language development, in particular, and these effects may be detectable within the first three years of life. Further, while male infants may be especially vulnerable to HIV/ART exposure, few studies overall reported sex-comparisons, and whether there are sex-dependent effects of HIV exposure on neurodevelopment remains a critical knowledge gap to fill. Lastly, early life nutrition interventions, including daily maternal multivitamin supplementation during the perinatal period, may improve neurodevelopmental outcomes for infants who are HIV-exposed. Our findings suggest that the early nutritional environment may be leveraged to improve early neurodevelopmental trajectories in infants who have been exposed to HIV in utero. A clear understanding of how this environment should be optimised is key for developing targeted nutrition interventions during critical developmental periods in order to mitigate adverse outcome later in life, and should be a priority of future research.

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Maternal HIV infection and preeclampsia increased risk of low birth weight among newborns delivered at University of Gondar specialized referral hospital, Northwest Ethiopia, 2017

Italian Journal of Pediatrics ◽

10.1186/s13052-019-0608-z ◽

2019 ◽

Vol 45 (1) ◽

Cited By ~ 3

Author(s):

Daniale Tekelia Ekubagewargies ◽

Destaye Guadie Kassie ◽

Wubet Worku Takele

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Hiv Infection ◽

Northwest Ethiopia ◽

Referral Hospital ◽

Increased Risk ◽

Maternal Hiv ◽

Maternal Hiv Infection

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In-utero exposure to maternal HIV infection alters T-cell immune responses to vaccination in HIV-uninfected infants

AIDS ◽

10.1097/qad.0000000000000292 ◽

2014 ◽

Vol 28 (10) ◽

pp. 1421-1430 ◽

Cited By ~ 47

Author(s):

Elvis B. Kidzeru ◽

Anneke C. Hesseling ◽

Jo-Ann S. Passmore ◽

Landon Myer ◽

Hoyam Gamieldien ◽

...

Keyword(s):

T Cell ◽

Immune Responses ◽

Hiv Infection ◽

In Utero ◽

In Utero Exposure ◽

Maternal Hiv ◽

T Cell Immune Responses ◽

Maternal Hiv Infection

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Does in utero HIV-exposure and the early nutritional environment influence infant development and immune outcomes? Findings from a pilot study in Pretoria, South Africa

10.1101/19003889 ◽

2019 ◽

Author(s):

Marina White ◽

Ute D Feucht ◽

Eleanor Duffley ◽

Felicia Molokoane ◽

Chrisna Durandt ◽

...

Keyword(s):

South Africa ◽

Pilot Study ◽

Health Outcomes ◽

Food Insecurity ◽

Infant Development ◽

In Utero ◽

New Mothers ◽

Women Living With Hiv ◽

Nutritional Environment ◽

Living With Hiv

AbstractBackgroundAs mother-to-child-transmission of HIV decreases, and the population of infants who are born HIV-exposed, but uninfected (HEU) continues to rise, there is growing need to understand the development and health outcomes of infants who are HEU to ensure that they have the healthiest start to life.MethodsIn a prospective cohort pilot study at Kalafong Hospital, Pretoria, South Africa, we aimed to determine if we could recruit new mothers living with HIV on antiretrovirals (ART; n=20) and not on ART (n=20), and new mothers without HIV (n=20) through our clinics to study the effects of HEU on growth, immune- and neuro-development in infants in early life, and test the hypothesis that infants who were HEU would have poorer health outcomes compared to infants who were HIV-unexposed, uninfected (HUU). We also undertook exploratory analyses to investigate relationships between the early nutritional environment, food insecurity, and infant development. Infant growth, neurodevelopment (Guide for Monitoring Child Development [GMCD]) and levels of monocyte subsets (CD14, CD16, and CCR2 expression [flow cytometry]) were measured in infants at birth and 12 weeks (range 8-16 weeks).ResultsWe recruited 33 women living with HIV on ART, and 22 women living without HIV within four days of delivery from June-December 2016. 21 women living with HIV and 10 without HIV returned for a follow-up appointment at 12 weeks postpartum. The high mobility of this population presented major challenges to participant retention. Preliminary analyses revealed lower head circumference and elevated CCR2+ (% and median fluorescence intensity) on monocytes at birth among infants who were HEU compared to HUU. Maternal reports of food insecurity were associated with lower maternal nutrient intakes at 12 weeks postpartum and increased risk of stunting at birth for infants who were HEU, but not infants who were HUU.ConclusionsOur small feasibility pilot study suggests that HEU may adversely affect infant development, and further, infants who are HEU may be even more vulnerable to the programming effects suboptimal nutrition in utero and postnatally. This pilot and preliminary analyses have been used to inform our research questions and protocol in our ongoing, full-scale study.

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Does in utero HIV exposure and the early nutritional environment influence infant development and immune outcomes? Findings from a pilot study in Pretoria, South Africa

Pilot and Feasibility Studies ◽

10.1186/s40814-020-00725-8 ◽

2020 ◽

Vol 6 (1) ◽

Author(s):

Marina White ◽

Ute D. Feucht ◽

Eleanor Duffley ◽

Felicia Molokoane ◽

Chrisna Durandt ◽

...

Keyword(s):

South Africa ◽

Pilot Study ◽

Health Outcomes ◽

Food Insecurity ◽

Infant Development ◽

In Utero ◽

New Mothers ◽

Women Living With Hiv ◽

Nutritional Environment ◽

Living With Hiv

Abstract Background As mother-to-child transmission of HIV decreases, and the population of infants who are born HIV-exposed, but uninfected (HEU) continues to rise, there is a growing need to understand the development and health outcomes of infants who are HEU to ensure that they have the healthiest start to life. Methods In a prospective cohort pilot study at Kalafong Hospital, Pretoria, South Africa, we aimed to determine if we could recruit new mothers living with HIV on antiretrovirals (ART; n = 20) and not on ART (n = 20) and new mothers without HIV (n = 20) through our clinics to study the effects of HEU on growth and immune- and neurodevelopment in infants in early life, and test the hypothesis that infants who were HEU would have poorer health outcomes compared to infants who were HIV-unexposed, uninfected (HUU). We also undertook exploratory analyses to investigate relationships between the early nutritional environment, food insecurity and infant development. Infant growth, neurodevelopment (Guide for Monitoring Child Development [GMCD]) and levels of monocyte subsets (CD14, CD16 and CCR2 expression [flow cytometry]) were measured in infants at birth and 12 weeks (range 8–16 weeks). Results We recruited 33 women living with HIV on ART and 22 women living without HIV within 4 days of delivery from June to December 2016. Twenty-one women living with HIV and 10 without HIV returned for a follow-up appointment at 12 weeks postpartum. The high mobility of this population presented major challenges to participant retention. Preliminary analyses revealed lower head circumference and elevated CCR2+ (% and median fluorescence intensity) on monocytes at birth among infants who were HEU compared to HUU. Maternal reports of food insecurity were associated with lower maternal nutrient intakes at 12 weeks postpartum and increased risk of stunting at birth for infants who were HEU, but not infants who were HUU. Conclusions Our small feasibility pilot study suggests that HEU may adversely affect infant development, and further, infants who are HEU may be even more vulnerable to the programming effects of suboptimal nutrition in utero and postnatally. This pilot and preliminary analyses have been used to inform our research questions and protocol in our ongoing, full-scale study.

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