title: Growth patterns among HIV-exposed infants receiving nevirapine prophylaxis in Pune, India.
abstract: BACKGROUND
  India 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.
  
  
  METHODS
  We 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.
  
  
  RESULTS
  Among 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.
  
  
  CONCLUSIONS
  Baseline 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.
  
  
  BACKGROUND
  NCT00061321.
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Dept, of International Health/GDEC, Suite W5506, 615 N, Wolfe Street, Baltimore, MD 21205, USA. mram@jhsph.edu
authors.forename: Malathi
authors.initials: M
authors.lastname: Ram
authors.forename: Nikhil
authors.initials: N
authors.lastname: Gupte
authors.forename: Uma
authors.initials: U
authors.lastname: Nayak
authors.forename: Aarti A
authors.initials: AA
authors.lastname: Kinikar
authors.forename: Mangesh
authors.initials: M
authors.lastname: Khandave
authors.forename: Anita V
authors.initials: AV
authors.lastname: Shankar
authors.forename: Jayagowri
authors.initials: J
authors.lastname: Sastry
authors.forename: Robert C
authors.initials: RC
authors.lastname: Bollinger
authors.forename: Amita
authors.initials: A
authors.lastname: Gupta
mesh_terms: D000328:Adult; D000886:Anthropometry; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy; D006679:HIV Seropositivity / Q000188:drug therapy; D006801:Humans; D007194:India; D007223:Infant; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical; D008297:Male; D019829:Nevirapine / Q000009:adverse effects* / Q000627:therapeutic use; D011247:Pregnancy; D011446:Prospective Studies; D012307:Risk Factors; D013851:Thinness / Q000175:diagnosis
chemical_list: D019829:Nevirapine