Diarrhea In HIV‐Exposed Tanzanian Infants Is Reduced With Maternal Antiretroviral Therapy

Abstract

BackgroundUse of maternal antiretroviral therapy (ART) is associated with higher survival among HIV‐exposed children, but data on its effect on child diarrhea, a major cause of morbidity, are limited.ObjectiveTo evaluate risk factors for diarrhea in HIV‐exposed infants in peri‐urban Dar es Salaam, Tanzania.MethodsHIV‐exposed infants were enrolled at age 6 weeks and followed for 24 months. Mothers kept written logs of monthly diarrhea episodes. Maternal and child factors were analyzed using generalizing estimating equations, including both time‐varying maternal ART use and child HIV infection on reports of subsequent diarrhea.Results2387 infants were enrolled from 2004‐08 in Dar es Salaam. With ART rollout, 429 mothers initiated ART during pregnancy and 151 initiated ART postpartum. 1814 diarrhea episodes were recorded. After controlling for maternal and child factors, maternal ART initiated during pregnancy was associated with a 21% reduction in subsequent diarrhea in children (RR 0.79, 95%CI 0.68‐0.91). Using maternal ART at any time reduced diarrhea risk by 23% (RR 0.77, 95%CI 0.67‐0.89). Other factors independently associated with diarrhea included HIV infection [RR 1.29 (1.10‐1.50)], exclusive breastfeeding [RR 0.67 (0.56‐0.80)] and higher spending on food [RR 0.67 (0.59‐0.77)].ConclusionsART use in mothers reduces risk of diarrhea in HIV‐exposed children. Future studies should examine the effect of maternal ART on other important childhood morbidities for HIV‐exposed children.SupportNIH R01HD043688‐01, K24HD058795