Decreased growth among antiretroviral drug and HIV exposed uninfected versus unexposed children in Malawi and Uganda.

Abstract

OBJECTIVE\nTo compare growth among antiretroviral drug and maternal-HIV exposed uninfected (AHEU) versus age-and-sex-matched HIV unexposed uninfected (HUU) children.\n\n\nDESIGN\nProspective cohort of AHEU children identified from the PROMISE trial (NCT01061151: clinicaltrials.gov registry) and age-and-sex-matched HUU controls from child-wellness clinics, enrolled (09/2013-10/2014) in Malawi and Uganda.\n\n\nMETHODS\nWeight-for-age (WAZ), length-for-age (LAZ), weight-for-length (WLZ), and head-circumference-for-age (HCAZ) z-scores were derived at 12 and 24 months-of-age. Wilcoxon Rank-Sum and Fischer s exact tests were used for unadjusted exposure group comparisons. Generalized-Estimating-Equations models estimated adjusted relative risks (aRR) for poor growth outcomes.\n\n\nRESULTS\nOverall, 471 (50.5%) AHEU and 462 (49.5%) HUU children were assessed. Ugandan AHEU compared to HUU children had significantly lower mean LAZ (p\u200a<\u200a0.001) and WAZ (p\u200a<\u200a0.001) at 12 and 24 months-of-age and HCAZ (p\u200a=\u200a0.016) at 24 months, with similar but not significant differences among Malawian AHEU and HUU children. The risk of stunting (more than two standard deviations below the WHO-population LAZ median) was increased among AHEU versus HUU children: aRR\u200a=\u200a2.13 (95% confidence interval (CI): 1.36, 3.33), p\u200a=\u200a0.001 at 12-months, and aRR\u200a=\u200a1.67 (95% CI: 1.16, 2.41), p\u200a=\u200a0.006 at 24-months-of-age in Uganda; and aRR\u200a=\u200a1.32 (95% CI: 1.10, 1.66), p\u200a=\u200a0.018, at 24-months-of-age in Malawi. The risk of HCAZ below WHO median was increased among AHEU versus HUU children at 24-months-of-age, aRR\u200a=\u200a1.35 (95% CI: 1.02, 1.79), p\u200a=\u200a0.038 in Uganda; and aRR\u200a=\u200a1.35 (95% CI: 0.91, 2.02), p\u200a=\u200a0.139 in Malawi.\n\n\nCONCLUSIONS\nPerinatal exposures to maternal-HIV and antiretroviral drugs were associated with lower LAZ (including stunting), WAZ and HCAZ at 24 months-of-age compared HUU children.