Maternal and infant predictors of CRP in exclusively breastfed infants born to HIV‐infected Malawian mothers

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Little is known about inflammation in young infants. We assessed C‐reactive protein (CRP) in exclusively breastfed (EBF) infants (n=537) born to HIV‐infected Malawian women in the Breastfeeding, Antiretrovirals and Nutrition Study (BAN). BAN mothers were randomized to receive a lipid‐based nutrient supplement (LNS), meeting nutritional needs of lactation, or no LNS and to a maternal, infant or no antiretroviral (ARV) regimen, with counseling for EBF to 24 weeks. Maternal and infant CRP levels were measured at 2 (n=366) or 6 (n=170) weeks, and 24 weeks. Infant CRP was elevated early (geometric mean at 2 weeks= 4.4 mg/L) but declined to 1.6 mg/L at 24 weeks, while maternal CRP increased from 0.65 to 1.82 mg/L. In linear regression models, log infant CRP at 6 weeks was significantly positively related to concurrently measured maternal BMI and CRP and inversely related to maternal CD4>500, but unrelated to treatment arm or infant BMI, sex, or infections. At 24 weeks, infant CRP was significantly related to infant infection and higher maternal BMI. Logistic regression comparing low to medium or high inflammation also showed that inflammation in young, EBF infants is driven mainly by maternal factors. By 24 weeks, while maternal factors still predicted infant CRP, infant infections became an important contributor to elevated CRP. Support: CDC U48‐DP000059‐01, Bill & Melinda Gates Foundation OPP53107, CPC R24 HD050924.