Impact of antenatal antiretroviral drug exposure on the growth of children who are HIV-exposed uninfected: the national South African Prevention of Mother to Child Evaluation cohort study

BMC Infectious Diseases

Research

Carl Lombard¹  Debra Jackson²  Louise Kuhn³  Ameena E. Goga⁴  Vundli Ramokolo⁵ 

[1] Biostatistics Unit, South African Medical Research Council, Tygerberg, South Africa;Division of Epidemiology and Biostatistics Unit, Department of Global Health, University of Stellenbosch, Tygerberg, South Africa;Centre for Maternal Adolescent Reproductive & Child Health (MARCH), London School of Hygiene and Tropical Medicine, London, UK;School of Public Health, University of the Western Cape, Cape Town, South Africa;Gertrude H. Sergievsky Center, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, USA;Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY, USA;HIV and Other Infectious Diseases Research Unit, South African Medical Research Council, 1 Francie Van Zyl Drive, Tygerberg, South Africa;Department of Paediatrics and Child Health, University of Pretoria, Pretoria, South Africa;HIV and Other Infectious Diseases Research Unit, South African Medical Research Council, 1 Francie Van Zyl Drive, Tygerberg, South Africa;Gertrude H. Sergievsky Center, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, USA;Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY, USA;

关键词: HIV-exposed uninfected;    Antiretroviral;    Postnatal growth;    Children;   

DOI  :  10.1186/s12879-022-07847-9

 received in 2022-05-13, accepted in 2022-11-06,  发布年份 2022

来源: Springer

【 摘 要 】

BackgroundThe relationship between in-utero antiretroviral (ARV) drug exposure and child growth needs further study as current data provide mixed messages. We compared postnatal growth in the first 18-months of life between children who are HIV-exposed uninfected (CHEU) with fetal exposure to ARV drugs (prophylaxis or triple-drug therapy (ART)) and CHEU not exposed to ARVs. We also examined other independent predictors of postnatal growth.MethodsWe analysed data from a national prospective cohort study of 2526 CHEU enrolled at 6-weeks and followed up 3-monthly till 18-months postpartum, between October 2012 and September 2014. Infant anthropometry was measured, and weight-for-age (WAZ) and length-for-age (LAZ) Z-scores calculated. Generalized estimation equation models were used to compare Z-scores between groups.ResultsAmong 2526 CHEU, 617 (24.4%) were exposed to ART since -pregnancy (pre-conception ART), 782 (31.0%) to ART commencing post-conception, 879 (34.8%) to maternal ARV prophylaxis (Azidothymidine (AZT)), and 248 (9.8%) had no ARV exposure. In unadjusted analyses, preterm birth rates were higher among CHEU with no ARV exposure than in other groups. Adjusting for infant age, the mean WAZ profile was lower among CHEU exposed to pre-conception ART [-0.13 (95% confidence interval − 0.26; − 0.01)] than the referent AZT prophylaxis group; no differences in mean WAZ profiles were observed for the post-conception ART (− 0.05 (− 0.16; 0.07)), None (− 0.05 (− 0.26; 0.16)) and newly-infected (− 0.18 (− 0.48; 0.13)) groups. Mean LAZ profiles were similar across all groups. In multivariable analyses, mean WAZ and LAZ profiles  for the ARV exposure groups were completely aligned. Several non-ARV factors including child, maternal, and socio-demographic factors independently predicted mean WAZ. These include child male (0.45 (0.35; 0.56)) versus female, higher maternal education grade 7–12 (0.28 (0.14; 0.42) and 12 + (0.36 (0.06; 0.66)) versus ≤ grade7, employment (0.16 (0.04; 0.28) versus unemployment, and household food security (0.17 (0.03; 0.31). Similar predictors were observed for mean LAZ.ConclusionFindings provide evidence for initiating all pregnant women living with HIV on ART as fetal exposure had no demonstrable adverse effects on postnatal growth. Several non-HIV-related maternal, child and socio-demographic factors were independently associated with growth, highlighting the need for multi-sectoral interventions. Longer-term monitoring of CHEU children is recommended.

【 授权许可】

CC BY   
© The Author(s) 2022

【 图 表 】

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Fig. 1