Growth patterns among HIV-exposed infants receiving nevirapine prophylaxis in Pune, India

BMC Infectious Diseases

Amita Gupta²  Robert C Bollinger²  Jayagowri Sastry¹  Anita V Shankar⁵  Mangesh Khandave⁴  Aarti A Kinikar⁶  Uma Nayak³  Nikhil Gupte⁴  Malathi Ram⁵ 

[1] Shrimati Kashibai Navale Medical College & Hospital, Narhe Pune, India;Johns Hopkins University School of Medicine, Infectious Diseases, Baltimore, MD, USA;University of Virginia School of Medicine, Department of Health Sciences, Charlottesville, VA, USA;BJMC-JHU Clinical Trials Unit, Pune, India;Johns Hopkins Bloomberg School of Public Health, Dept. of International Health/GDEC, Suite W5506, 615 N. Wolfe Street, Baltimore, MD 21205, USA;BJ Medical College & Sassoon General Hospitals, Pune, India

关键词: Timing of HIV Infection;    Risk factors;    Extended use of nevirapine;    India;    Growth patterns;    HIV-exposed infants;   

Others  :  1159609
DOI  :  10.1186/1471-2334-12-282

 received in 2011-12-21, accepted in 2012-10-26,  发布年份 2012

【 摘 要 】

Background

India has among the highest rates of infant malnutrition. Few studies investigating the growth patterns of HIV-exposed infants in India or the impact of timing of HIV infection on growth in settings such as India exist.

Methods

We used data from the Six Week Extended Nevirapine (SWEN) trial to compare the growth patterns of HIV-infected and HIV-exposed but uninfected infants accounting for timing of HIV infection, and to identify risk factors for stunting, underweight and wasting. Growth and timing of HIV infection were assessed at weeks 1, 2, 4, 6, 10, 14 weeks and 6, 9, 12 months of life. Random effects multivariable logistic regression method was used to assess factors associated with stunting, underweight and wasting.

Results

Among 737 HIV-exposed infants, 93 (13%) were HIV-infected by 12 months of age. Among HIV-infected and uninfected infants, baseline prevalence of stunting (48% vs. 46%), underweight (27% vs. 26%) and wasting (7% vs. 11%) was similar (p>0.29), but by 12 months stunting and underweight, but not wasting, were significantly higher in HIV-infected infants (80% vs. 56%, 52% vs. 29%, p< 0.0001; 5% vs. 6%, p=0.65, respectively). These differences rapidly manifested within 4–6 weeks of birth. Infants infected in utero had the worst growth outcomes during the follow-up period. SWEN was associated with non-significant reductions in stunting and underweight among HIV-infected infants and significantly less wasting in HIV-uninfected infants. In multivariate analysis, maternal CD4 < 250, infant HIV status, less breastfeeding, low birth weight, non-vaginal delivery, and infant gestational age were significant risk factors for underweight and stunting.

Conclusion

Baseline stunting and underweight was high in both HIV-infected and uninfected infants; growth indices diverged early and were impacted by timing of infection and SWEN prophylaxis. Early growth monitoring of all HIV-exposed infants is an important low-cost strategy for improving health and survival outcomes of these infants.

Trial Registration

NCT00061321

【 授权许可】

   
2012 Ram et al.; licensee BioMed Central Ltd.

【 图 表 】

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