Growth of infants born to HIV-infected women in South Africa according to maternal and infant characteristics.
OBJECTIVE
To evaluate growth parameters assessed by weight and length in HIV-infected and HIV-uninfected infants born to HIV-infected mothers in South Africa from birth to 6 months of age.


METHODS
We calculated z-scores for weight-for-age (WAZ), length-for-age (LAZ) and weight-for-length (WLZ) among a cohort of 840 mother-infant dyads. Multivariable Cox proportional hazards models with time-varying covariates were used to estimate the risk of falling <-2 z-scores for WAZ, LAZ, and WLZ as a function of infant and maternal characteristics.


RESULTS
By 6 months after birth, a fifth of infants had WAZ <-2, 19% had an LAZ <-2, and 29% had a WLZ <-2. WLZ and WAZ were significantly lower in HIV-infected infants than in uninfected infants by 3 months of age and LAZ by 6 months of age (P<0.001). The risk of WAZ falling <-2 was associated with decreasing maternal CD4 cell count (adj. HR for CD4 cell count <200 cells/μl: 1.64; 95% CI: 1.10-2.43), premature birth (adj. HR: 2.82; 95% CI: 2.06-3.86) and formula feeding (adj. HR: 3.35; 95% CI: 1.64-6.85). The risk of LAZ falling <-2 was associated with increasingly lower maternal age (adj. HR for<20 years: 0.54; 95% CI: 0.31-0.96), lower maternal CD4 cell count (adj. HR for CD4 cell count <200 cells/μl: 1.72; 95% CI: 1.14-2.59), premature birth (adj. HR: 2.37; 95% CI: 1.70-3.30) and formula feeding (adj. HR: 4.22; 95% CI: 1.85-9.62). The risk of WLZ falling <-2 was significantly associated with infant HIV infection (adj. HR: 1.64; 95% CI: 1.16-2.32) and formula feeding (adj. HR: 1.78; 95% CI: 1.11-2.83). The risk of WAZ and LAZ falling <-2 was more than two times greater for HIV-infected infants than for uninfected infants with gastrointestinal infections.


CONCLUSIONS
HIV-infected infants were more likely to be stunted and wasted than uninfected infants, which often occurred within 3 months after birth. Infants who were born to mothers with advanced HIV disease, formula-fed and co-infected with HIV and gastrointestinal infections were at greater risk for growth disturbances. Further interventions are needed to promptly initiate both HIV-infected mothers and infants on appropriate antiretroviral therapy and nutritional supplementation.
Department of Community Health, Alpert Medical School, Brown University, Providence, RI, USA.
Kartik K
KK
Venkatesh
Mark N
MN
Lurie
Elizabeth W
EW
Triche
Guy
G
De Bruyn
Joseph I
JI
Harwell
Stephen T
ST
McGarvey
Glenda E
GE
Gray
D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D001827:Body Height / Q000502:physiology; D001835:Body Weight / Q000502:physiology; D018791:CD4 Lymphocyte Count; D004812:Epidemiologic Methods; D005260:Female; D006130:Growth Disorders / Q000503:physiopathology / Q000821:virology*; D015658:HIV Infections / Q000150:complications* / Q000517:prevention & control / Q000635:transmission / Q000821:virology; D006801:Humans; D041943:Infant Formula; D007227:Infant Nutritional Physiological Phenomena / Q000502:physiology; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control; D008297:Male; D008423:Maternal Age; D019829:Nevirapine / Q000627:therapeutic use; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000821:virology; D019562:Viral Load; D055815:Young Adult; D015215:Zidovudine / Q000627:therapeutic use
D019380:Anti-HIV Agents; D015215:Zidovudine; D019829:Nevirapine