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Growth of infants born to HIV‐infected women in South Africa according to maternal and infant characteristics
Author(s) -
Venkatesh Kartik K.,
Lurie Mark N.,
Triche Elizabeth W.,
De Bruyn Guy,
Harwell Joseph I.,
McGarvey Stephen T.,
Gray Glenda E.
Publication year - 2010
Publication title -
tropical medicine and international health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.056
H-Index - 114
eISSN - 1365-3156
pISSN - 1360-2276
DOI - 10.1111/j.1365-3156.2010.02634.x
Subject(s) - medicine , human immunodeficiency virus (hiv) , developing country , demography , pediatrics , geography , virology , biology , sociology , ecology
Summary Objective To evaluate growth parameters assessed by weight and length in HIV‐infected and HIV‐uninfected infants born to HIV‐infected mothers in South Africa from birth to 6 months of age. Methods We calculated z ‐scores for weight‐for‐age (WAZ), length‐for‐age (LAZ) and weight‐for‐length (WLZ) among a cohort of 840 mother–infant dyads. Multivariable Cox proportional hazards models with time‐varying covariates were used to estimate the risk of falling <−2 z ‐scores for WAZ, LAZ, and WLZ as a function of infant and maternal characteristics. Results By 6 months after birth, a fifth of infants had WAZ <−2, 19% had an LAZ <−2, and 29% had a WLZ <−2. WLZ and WAZ were significantly lower in HIV‐infected infants than in uninfected infants by 3 months of age and LAZ by 6 months of age ( P < 0.001). The risk of WAZ falling <−2 was associated with decreasing maternal CD4 cell count (adj. HR for CD4 cell count <200 cells/μl: 1.64; 95% CI: 1.10–2.43), premature birth (adj. HR: 2.82; 95% CI: 2.06–3.86) and formula feeding (adj. HR: 3.35; 95% CI: 1.64–6.85). The risk of LAZ falling <−2 was associated with increasingly lower maternal age (adj. HR for<20 years: 0.54; 95% CI: 0.31–0.96), lower maternal CD4 cell count (adj. HR for CD4 cell count <200 cells/μl: 1.72; 95% CI: 1.14–2.59), premature birth (adj. HR: 2.37; 95% CI: 1.70–3.30) and formula feeding (adj. HR: 4.22; 95% CI: 1.85–9.62). The risk of WLZ falling <−2 was significantly associated with infant HIV infection (adj. HR: 1.64; 95% CI: 1.16–2.32) and formula feeding (adj. HR: 1.78; 95% CI: 1.11–2.83). The risk of WAZ and LAZ falling <−2 was more than two times greater for HIV‐infected infants than for uninfected infants with gastrointestinal infections. Conclusions HIV‐infected infants were more likely to be stunted and wasted than uninfected infants, which often occurred within 3 months after birth. Infants who were born to mothers with advanced HIV disease, formula‐fed and co‐infected with HIV and gastrointestinal infections were at greater risk for growth disturbances. Further interventions are needed to promptly initiate both HIV‐infected mothers and infants on appropriate antiretroviral therapy and nutritional supplementation.