High Burden of Morbidity and Mortality but Not Growth Failure in Infants Exposed to but Uninfected with Human Immunodeficiency Virus in Tanzania.
To compare health and growth outcomes in children infected with HIV, children exposed to but uninfected with HIV, and children unexposed to HIV.



Our cohort included 3554 Tanzanian children enrolled in 2 trials of micronutrient supplementation. Among infants born to mothers infected with HIV, 264 were infected with HIV and 2088 were exposed to but uninfected at 6 weeks of age. An additional 1202 infants were unexposed to HIV. Infants were followed until 18 months of age, death, or loss to follow-up. Morbidity and growth were assessed at monthly nurse visits.



Compared with unexposed infants, hazard ratios (95% CI) for all-cause mortality in infants infected with HIV and infants who were exposed to but uninfected with HIV were 28.99 (14.83-56.66) and 2.79 (1.41-5.53), respectively, after adjusting for demographic and nutritional covariates. Compared with infants unexposed to HIV, infants infected with HIV also had a significantly greater risk of all measured morbidities, while infants who were exposed to but uninfected with HIV were significantly more likely to suffer from cough, fever, unscheduled outpatient visits, and hospitalizations. Infants infected with HIV also were more likely to experience stunting, wasting, and underweight at baseline and during follow-up. Infants exposed to but uninfected with HIV were more likely to be underweight at baseline (adjusted relative risk, 2.05; 95% CI, 1.45-2.89), but on average, experienced slower declines in height-for-age z-score, weight-for-age z-score, and weight-for-height z-score as well as a lower rate of stunting over follow-up, compared with unexposed infants.



In addition to preventing and treating HIV infection in infants, prevention-of-mother-to-child-transmission of HIV and child health services should also target children exposed to but uninfected with HIV to improve health outcomes in this vulnerable population.



Clinicaltrials.gov: NCT00197730 and NCT00421668.
Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA.
Lindsey M
LM
Locks
Department of Pediatrics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
Karim P
KP
Manji
Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA; UNICEF Headquarters, New York, NY.
Roland
R
Kupka
Clinical Research Center, Boston Children's Hospital, Boston, MA.
Enju
E
Liu
Department of Pediatrics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
Rodrick
R
Kisenge
Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA.
Christine M
CM
McDonald
Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
Said
S
Aboud
Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA.
Molin
M
Wang
Department of Nutrition, Department of Epidemiology, Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA.
Wafaie W
WW
Fawzi
Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA; Department of Nutrition, Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA. Electronic address: christopher.duggan@childrens.harvard.edu.
Christopher P
CP
Duggan
D000328:Adult; D017281:Cost of Illness; D005260:Female; D006130:Growth Disorders / Q000453:epidemiology / Q000209:etiology* / Q000401:mortality*; D015658:HIV Infections / Q000150:complications* / Q000453:epidemiology / Q000635:transmission; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical; D008297:Male; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious; D011446:Prospective Studies; D013636:Tanzania / Q000453:epidemiology
HIV; HIV-exposed-uninfected; child health; growth; morbidity; mortality