title: Maternal Antiretroviral Therapy Is Associated with Lower Risk of Diarrhea in Early Childhood.
abstract: To identify risk factors, including maternal antiretroviral therapy (ART), for diarrhea in Tanzanian children exposed to HIV during the first 2 years of life.
  
  
  
  Using generalized estimating equations, we analyzed data from a cohort of 2387 Tanzanian children exposed to HIV from age 6 weeks to 2 years, as well as data from their mothers, to determine risk factors for diarrhea in children. Mothers recorded diarrhea in a diary and reported results at visits scheduled every four weeks.
  
  
  
  Body mass index was ≥18.5 in 95.6% of mothers. World Health Organization HIV stage was 1/2 for 1255 (87.8%) mothers. ART was received by 24.3% of mothers, most initiating ART during pregnancy. At baseline (6 weeks of age) 264 (11.3%) children were infected with HIV. In children whose mothers received ART, the relative risk of diarrhea in children was 0.79 (95% CI 0.68-0.92), after we adjusted for multiple factors, including child HIV status and exclusive breastfeeding duration. Exclusive breastfeeding (relative risk 0.67, 95% CI 0.56-0.80) also was protective.
  
  
  
  Our results provide additional support to increase ART coverage for all pregnant mothers, to control clinical HIV progression, reduce perinatal HIV infection, but also to reduce the risk of a major cause of death and morbidity in young children worldwide.
  
  
  
  ClinicalTrials.gov: NCT00197730.
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA. Electronic address: Kevin.Sztam@childrens.harvard.edu.
authors.forename: Kevin A
authors.initials: KA
authors.lastname: Sztam
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA.
authors.forename: Enju
authors.initials: E
authors.lastname: Liu
authors.affiliation: Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
authors.forename: Karim P
authors.initials: KP
authors.lastname: Manji
authors.affiliation: Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA; Nutrition Section, UNICEF Headquarters, New York, NY.
authors.forename: Roland
authors.initials: R
authors.lastname: Kupka
authors.affiliation: Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
authors.forename: Rodrick
authors.initials: R
authors.lastname: Kisenge
authors.affiliation: Department of Microbiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
authors.forename: Said
authors.initials: S
authors.lastname: Aboud
authors.affiliation: Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA.
authors.forename: Wafaie W
authors.initials: WW
authors.lastname: Fawzi
authors.affiliation: Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA.
authors.forename: Ronald J
authors.initials: RJ
authors.lastname: Bosch
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA.
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Duggan
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D001942:Breast Feeding; D002675:Child, Preschool; D003967:Diarrhea / Q000209:etiology* / Q000517:prevention & control; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000517:prevention & control / Q000635:transmission; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control; D008297:Male; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy*; D011297:Prenatal Exposure Delayed Effects / Q000209:etiology*; D011446:Prospective Studies; D065840:Protective Factors; D012307:Risk Factors; D013636:Tanzania; D016896:Treatment Outcome
chemical_list: D019380:Anti-HIV Agents
keywords: ART; HIV; breastfeeding; pediatrics; sub-Saharan Africa