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

BMC Infectious Diseases

Research Article

Aarti A Kinikar¹  Nikhil Gupte²  Mangesh Khandave²  Malathi Ram³  Anita V Shankar³  Amita Gupta⁴  Robert C Bollinger⁴  Jayagowri Sastry⁵  Uma Nayak⁶ 

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

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

DOI  :  10.1186/1471-2334-12-282

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

来源: Springer

【 摘 要 】

BackgroundIndia 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.MethodsWe 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.ResultsAmong 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.ConclusionBaseline 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 RegistrationNCT00061321

【 授权许可】

CC BY   
© Ram et al.; licensee BioMed Central Ltd. 2012