Growth patterns among HIV-exposed infants receiving nevirapine prophylaxis in Pune, India

Malathi Ram,Robert C Bollinger,Mangesh Khandave,Aarti A Kinikar,Uma Nayak,Nikhil Gupte,Amita Gupta,Jayagowri Sastry,Anita V Shankar

doi:10.1186/1471-2334-12-282

Abstract

BackgroundIndia has among the highest rates of infant malnutrition. Few studies investigating the growth patterns of HIV-exposed infants in India or the impact of timing of HIV infection on growth in settings such as India exist.MethodsWe used data from the Six Week Extended Nevirapine (SWEN) trial to compare the growth patterns of HIV-infected and HIV-exposed but uninfected infants accounting for timing of HIV infection, and to identify risk factors for stunting, underweight and wasting. Growth and timing of HIV infection were assessed at weeks 1, 2, 4, 6, 10, 14 weeks and 6, 9, 12 months of life. Random effects multivariable logistic regression method was used to assess factors associated with stunting, underweight and wasting.ResultsAmong 737 HIV-exposed infants, 93 (13%) were HIV-infected by 12 months of age. Among HIV-infected and uninfected infants, baseline prevalence of stunting (48% vs. 46%), underweight (27% vs. 26%) and wasting (7% vs. 11%) was similar (p>0.29), but by 12 months stunting and underweight, but not wasting, were significantly higher in HIV-infected infants (80% vs. 56%, 52% vs. 29%, p< 0.0001; 5% vs. 6%, p=0.65, respectively). These differences rapidly manifested within 4–6 weeks of birth. Infants infected in utero had the worst growth outcomes during the follow-up period. SWEN was associated with non-significant reductions in stunting and underweight among HIV-infected infants and significantly less wasting in HIV-uninfected infants. In multivariate analysis, maternal CD4 < 250, infant HIV status, less breastfeeding, low birth weight, non-vaginal delivery, and infant gestational age were significant risk factors for underweight and stunting.ConclusionBaseline stunting and underweight was high in both HIV-infected and uninfected infants; growth indices diverged early and were impacted by timing of infection and SWEN prophylaxis. Early growth monitoring of all HIV-exposed infants is an important low-cost strategy for improving health and survival outcomes of these infants.Trial RegistrationNCT00061321

Highlights

India has among the highest rates of infant malnutrition
Since infants in our study were randomized to receive Six Week Extended Nevirapine (SWEN) or single dose nevirapine (SdNVP), we examined whether the SWEN dose afforded any additional benefit to the infants as evidenced by their anthropometric indices and whether Human immunodeficiency virus (HIV) infection had any impact on growth
Our study of growth patterns of infants born to HIVinfected mothers has revealed interesting and important findings not previously reported for such infants in India

Summary

Introduction

Few studies investigating the growth patterns of HIV-exposed infants in India or the impact of timing of HIV infection on growth in settings such as India exist. As a result of inadequate nutritional intake and/or increased susceptibility to infections, poses an increased risk of mortality among children [1]. Abnormal growth patterns in HIV-infected children have been documented in both developed and developing country settings [9,10,11,12,13,14,15,16,17,18,19,20]. For children that are already suffering with poor nutritional status, concurrent HIV infection poses substantial additional risks for morbidity and mortality

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