Growth of HIV-exposed uninfected, compared with HIV-unexposed, Zambian children: a longitudinal analysis from infancy to school age

Anna Rosala-Hallas,Jonathan W Bartlett,Suzanne Filteau

doi:10.1186/s12887-017-0828-6

Abstract

BackgroundEarly growth of HIV-exposed, uninfected (HEU) children is poorer than that of their HIV-unexposed, uninfected (HUU) counterparts but there is little longitudinal or longer term information about the growth effects of early HIV exposure.MethodsWe performed a longitudinal analysis to compare growth of HEU and HUU infants and children using data from two cohort studies in Lusaka, Zambia. Initially 207 HUU and 200 HEU infants from the Breastfeeding and Postpartum Health (BFPH) study and 580 HUU and 165 HEU from the Chilenje Infant Growth, Nutrition and Infection Study (CIGNIS) had anthropometric measurements taken during infancy and again when school-aged, at which time 66 BFPH children and 326 CIGNIS children were available. We analysed the data from the two cohorts separately using linear mixed models. Linear regression models were used as a secondary analysis at the later time points, adjusting for breastfeeding duration. We explored when the main group differences in growth emerged in order to estimate the largest ‘effect periods’.ResultsAfter adjusting for socioeconomic status and maternal education, HEU children had lower weight-for-age, length-for-age and BMI-for-age Z-scores during early growth and these differences still existed when children were school-aged. Exposure group differences changed most between 1 and 6 weeks and between 18 months and ~7.5 years.ConclusionsHEU children have poorer early growth than HUU children which persists into later growth. Interventions to improve growth of HEU children need to target pregnant women and infants.

Highlights

Growth of Human Immunodeficiency Virus (HIV)-exposed, uninfected (HEU) children is poorer than that of their HIV-unexposed, uninfected (HUU) counterparts but there is little longitudinal or longer term information about the growth effects of early HIV exposure
With the exception of week 1 length in the Breastfeeding and Postpartum Health (BFPH) cohort, at each visit point estimates for anthropometry suggested that HEU children in both cohorts were shorter and lighter than HUU children (Table 2)
For the BFPH cohort, after adjusting for maternal education and housing density, there was evidence at the 5% level that weight-for-age Z-scores were lower in HEU children compared with HUU children (Fig. 1 and Table 3) at all time points

Summary

Introduction

Growth of HIV-exposed, uninfected (HEU) children is poorer than that of their HIV-unexposed, uninfected (HUU) counterparts but there is little longitudinal or longer term information about the growth effects of early HIV exposure. Most data from Africa, the centre of the HIV epidemic, is restricted to infancy and early childhood [5,6,7,8,9,10] or lacks appropriate non-HIV-exposed controls [11]. In spite of these data limitations, as well as the varying exposure to antiretroviral drugs in these studies, there is evidence of both linear and ponderal growth faltering in HEU children. The aim of this analysis was to determine whether the early and later

Methods

Results

Conclusion