title: Looking beyond prevention of parent to child transmission: Impact of maternal factors on growth of HIV-exposed uninfected infant.
abstract: BACKGROUND
  Compared to HIV-infected children, relatively little has been described regarding the health status, particularly growth of HIV-exposed but uninfected children in resource-limited settings. This is particularly relevant with widespread implementation of the prevention of parent to child transmission program.
  
  
  METHODS
  At a tertiary care health institute in India, a cohort of 44 HIV-exposed but uninfected children were followed through 6 months of age. The anthropometric parameters weight, length, and head circumference were investigated at birth, 3 weeks, 6 weeks, 3 months, and 6 months point of time. The information on maternal characteristics such as HIV clinical staging, CD4 count, and maternal weight were recorded. The linear regression analysis was applied to estimate the influence of maternal characteristics on infant anthropometric parameters.
  
  
  RESULTS
  Anthropometric parameters (weight, length and head circumference) were significantly reduced in uninfected new-borns of mothers in HIV Clinical stage III and IV and weight <50 kg compared to mothers in HIV Clinical stage I and II and weight >50 kg. Analysis conducted to find the effect of maternal immunosuppression on infant growth reveals a significant difference at CD4 300 cells/mm(3) and not at established cut-off of CD4 350 cells/mm(3). This trend of difference continued at 6 weeks, 3 months, and 6 months. The multiple linear regression analysis model demonstrated maternal HIV clinical stage and weight as predictors for birth weight and length, respectively.
  
  
  CONCLUSIONS
  Advanced HIV disease in the mother is associated with poor infant growth in HIV-exposed, but uninfected children at a critical growth phase in life. These results underscore the importance, especially in resource-constrained settings, of early HIV diagnosis and interventions to halt disease progression in all pregnant women.
authors.affiliation: Department of Paediatrics, Government Medical College, Surat, Gujarat, India.
authors.forename: Trivedi
authors.initials: T
authors.lastname: Sangeeta
authors.affiliation: Department of Community Medicine, Government Medical College, Surat, Gujarat, India.
authors.forename: Modi
authors.initials: M
authors.lastname: Anjali
authors.affiliation: Department of Paediatrics, Government Medical College, Surat, Gujarat, India.
authors.forename: Modi
authors.initials: M
authors.lastname: Silky
authors.affiliation: Department of Community Medicine, Government Medical College, Surat, Gujarat, India.
authors.forename: J K
authors.initials: JK
authors.lastname: Kosambiya
authors.affiliation: Department of Paediatrics, Government Medical College, Surat, Gujarat, India.
authors.forename: V B
authors.initials: VB
authors.lastname: Shah
keywords: HIV-exposed infants; PPTCT; maternal HIV