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Diarrhea In HIV‐Exposed Tanzanian Infants Is Reduced With Maternal Antiretroviral Therapy
Author(s) -
Sztam Kevin,
Liu Enju,
Manji Karim,
Kupka Roland,
Kisenge Rodrick,
Aboud Said,
Bosch Ronald,
Fawzi Wafaie,
Duggan Christopher
Publication year - 2015
Publication title -
the faseb journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.709
H-Index - 277
eISSN - 1530-6860
pISSN - 0892-6638
DOI - 10.1096/fasebj.29.1_supplement.898.47
Subject(s) - diarrhea , breastfeeding , medicine , dar es salaam , tanzania , pediatrics , pregnancy , antiretroviral therapy , relative risk , human immunodeficiency virus (hiv) , obstetrics , immunology , viral load , confidence interval , environmental planning , genetics , environmental science , biology
Background Use of maternal antiretroviral therapy (ART) is associated with higher survival among HIV‐exposed children, but data on its effect on child diarrhea, a major cause of morbidity, are limited. Objective To evaluate risk factors for diarrhea in HIV‐exposed infants in peri‐urban Dar es Salaam, Tanzania. Methods HIV‐exposed infants were enrolled at age 6 weeks and followed for 24 months. Mothers kept written logs of monthly diarrhea episodes. Maternal and child factors were analyzed using generalizing estimating equations, including both time‐varying maternal ART use and child HIV infection on reports of subsequent diarrhea. Results 2387 infants were enrolled from 2004‐08 in Dar es Salaam. With ART rollout, 429 mothers initiated ART during pregnancy and 151 initiated ART postpartum. 1814 diarrhea episodes were recorded. After controlling for maternal and child factors, maternal ART initiated during pregnancy was associated with a 21% reduction in subsequent diarrhea in children (RR 0.79, 95%CI 0.68‐0.91). Using maternal ART at any time reduced diarrhea risk by 23% (RR 0.77, 95%CI 0.67‐0.89). Other factors independently associated with diarrhea included HIV infection [RR 1.29 (1.10‐1.50)], exclusive breastfeeding [RR 0.67 (0.56‐0.80)] and higher spending on food [RR 0.67 (0.59‐0.77)]. Conclusions ART use in mothers reduces risk of diarrhea in HIV‐exposed children. Future studies should examine the effect of maternal ART on other important childhood morbidities for HIV‐exposed children. Support NIH R01HD043688‐01, K24HD058795

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