title: Growth and health outcomes at school age in HIV-exposed, uninfected Zambian children: follow-up of two cohorts studied in infancy.
abstract: BACKGROUND
  Early growth and health of HIV-exposed, uninfected (HEU) children is poorer than that of their HIV-unexposed, uninfected (HUU) counterparts but there is little information about longer term effects of early HIV exposure. We previously recruited two cohorts of HEU and HUU Zambian infants and documented the poorer infant growth and health of the HEU compared to the HUU children. We followed up HEU and HUU children from these cohorts when they were school-aged and compared their growth, health, biochemical markers of acute or chronic disease, and school grades.
  
  
  METHODS
  We recruited 111 HEU and 279 HUU children aged 6-12 years. We measured anthropometry, determined health by questionnaire and clinical examination, viewed the child's most recent school report, and measured blood pressure, haemoglobin (Hb), HbA1c, glucose, cholesterol, and C-reactive protein (CRP).
  
  
  RESULTS
  Anthropometric measures were lower among HEU than HUU children, significantly so for hip circumference (age- and sex-adjusted difference -1.74 cm; 95% confidence interval (CI) -3.24, -0.24; P = 0.023) and mid-upper-arm circumference (adjusted difference -0.63 cm, 95% CI -1.23, -0.04; P = 0.037) and with borderline effects for body mass index, thigh circumference and subscapular skinfolds. HEU children had significantly lower total, trunk, and limb fat percentages. All anthropometric and body composition differences became non-significant after adjustment for sociodemographic variables which differed between HEU and HUU children. More HEU than HUU children reported minor illnesses and were prescribed medication at the time of visit. There were no differences in biochemical markers between groups. HEU children had lower math grades than HUU children even after adjustment for socioeconomic variables.
  
  
  CONCLUSIONS
  Although HEU children were smaller and had lower percent fat than HUU children, this appeared to be due mainly to their poorer socioeconomic status. Reasons for lower school grades require further research.
authors.affiliation: Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, UK. laura.b.nichol@gmail.com.
authors.forename: Laura
authors.initials: L
authors.lastname: Nicholson
authors.affiliation: Department of Obstetrics and Gynecology, University Teaching Hospital, Lusaka, Zambia. mchisenga04@yahoo.co.uk.
authors.forename: Molly
authors.initials: M
authors.lastname: Chisenga
authors.affiliation: Department of Obstetrics and Gynecology, University Teaching Hospital, Lusaka, Zambia. josiame@yahoo.com.
authors.forename: Joshua
authors.initials: J
authors.lastname: Siame
authors.affiliation: Department of Obstetrics and Gynecology, University Teaching Hospital, Lusaka, Zambia. kasonkalm@gmail.com.
authors.forename: Lackson
authors.initials: L
authors.lastname: Kasonka
authors.affiliation: Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, UK. Suzanne.Filteau@lshtm.ac.uk.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Filteau
mesh_terms: D000124:Achievement; D000886:Anthropometry; D015415:Biomarkers; D001823:Body Composition; D002648:Child; D002657:Child Development; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections; D006304:Health Status; D006801:Humans; D008297:Male; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious; D011297:Prenatal Exposure Delayed Effects; D012959:Socioeconomic Factors; D015024:Zambia
chemical_list: D015415:Biomarkers