HIV / STI
In utero HIV exposure and anthropometry trajectories from birth through 8 years of age: findings from a prospective birth cohort in South Africa Angela Bengtson* Angela Bengtson Bengtson Bengtson Bengtson Bengtson Bengtson Bengtson Bengtson Bengtson Bengtson Emory University
Children who are HIV-exposed but uninfected (CHEU) may have suboptimal growth, but few data are available beyond infancy to inform public health strategies. We investigated anthropometry trajectories from 6 weeks to 8 years in a South African birth cohort, the Drakenstein Child Health study. Anthropometry was assessed at least annually by trained study staff and converted to weight-for-age (WAZ), height-for-age (HAZ), and body mass index (BMIZ) z-scores. Stunting (HAZ <-2SD from 12 months) and overweight (BMIZ score >2 SD from 6 months) were secondary outcomes. Multivariable linear mixed effects models were used to estimate associations between HIV exposure status and anthropometry trajectories and explore the impact of maternal HIV factors among CHEU. Among 1,072 children (CHEU n= 236 (22%), children unexposed to HIV (CHU) n= 836 (78%)) mean birthweight (CHEU 3012g (SD 598) vs CHU 3041g (SD 590)) and preterm birth status (CHEU 18.3% CHEU vs CHU 15.0%) were similar. Among pregnant women with HIV, 99% were on antiretroviral therapy (ART; 80% efavirenz-based ART), and 65% had an undetectable viral load. In multivariable analyses, CHEU had lower marginal WAZ (marginal difference (MD) -0.16 (95% CI -0.32, -0.01) and marginal HAZ (MD -0.26, 95% CI -0.41, -0.11) scores, compared to CHU. Differences in WAZ and HAZ were largest before 3 years of age, but similar between CHEU and CHU thereafter. There was no association between HIV exposure and BMIZ scores (MD -0.02, 95% CI -0.17, 0.12), stunting (MD 0.05, 95% CI -0.04, 0.13) or overweight (MD 0.05, 95% CI -0.04, 0.13) overall or at specific time points. Among CHEU, timing of maternal ART initiation, ART regimen, and viral load in pregnancy were not associated with anthropometry outcomes. Compared to CHU, CHEU had lower marginal weight and height from birth to 8 years, driven by differences before 3 years of age. Among CHEU, maternal HIV factors did not drive anthropometry outcomes.
