Impact of HIV exposure on health outcomes in HIV-negative infants born to HIV-positive mothers in Sub-Saharan Africa.
BACKGROUND
Up to 30% of infants may be HIV-exposed noninfected (ENI) in countries with high HIV prevalence, but the impact of maternal HIV on the child's health remains unclear.


METHODS
One hundred fifty-eight HIV ENI and 160 unexposed (UE) Mozambican infants were evaluated at 1, 3, 9, and 12 months postdelivery. At each visit, a questionnaire was administered, and HIV DNA polymerase chain reaction and hematologic and CD4/CD8 determinations were measured. Linear mixed models were used to evaluate differences in hematologic parameters and T-cell counts between the study groups. All outpatient visits and admissions were registered. ENI infants received cotrimoxazol prophylaxis (CTXP). Negative binomial regression models were estimated to compare incidence rates of outpatient visits and admissions.


RESULTS
Hematocrit was lower in ENI than in UE infants at 1, 3, and 9 months of age (P = 0.024, 0.025, and 0.012, respectively). Percentage of CD4 T cells was 3% lower (95% confidence interval: 0.86 to 5.15; P = 0.006) and percentage of CD8 T cells 1.15 times higher (95% confidence interval: 1.06 to 1.25; P = 0.001) in ENI vs. UE infants. ENI infants had a lower weight-for-age Z score (P = 0.049) but reduced incidence of outpatient visits, overall (P = 0.042), diarrhea (P = 0.001), and respiratory conditions (P = 0.042).


CONCLUSIONS
ENI children were more frequently anemic, had poorer nutritional status, and alterations in some immunologic profiles compared with UE children. CTXP may explain their reduced mild morbidity. These findings may reinforce continuation of CTXP and the need to understand the consequences of maternal HIV exposure in this vulnerable group of children.
*Manhiça Health Research Centre (CISM), Maputo, Mozambique; †Barcelona Centre for International Health Research (CRESIB), Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; ‡National Institute of Health, Maputo, Mozambique; and §National Directorate of Health, Ministry of Health, Maputo, Mozambique.
Cinta
C
Moraleda
Nilsa
N
de Deus
Celia
C
Serna-Bolea
Montse
M
Renom
Llorenç
L
Quintó
Eusebio
E
Macete
Clara
C
Menéndez
Denise
D
Naniche
D000293:Adolescent; D000328:Adult; D017954:Africa South of the Sahara; D000740:Anemia / Q000453:epidemiology; D018791:CD4 Lymphocyte Count; D016516:CD4-CD8 Ratio; D002657:Child Development; D004279:DNA, Viral / Q000097:blood; D005260:Female; D015658:HIV Infections / Q000473:pathology*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D044342:Malnutrition / Q000453:epidemiology; D009035:Mothers; D009073:Mozambique / Q000453:epidemiology; D016133:Polymerase Chain Reaction; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D055815:Young Adult
D004279:DNA, Viral