In-utero triple antiretroviral exposure associated with decreased growth among HIV-exposed uninfected infants in Botswana. (January 2016)

• Record Type: Journal Article
• Authors: Powis, Kathleen M.; Smeaton, Laura; Hughes, Michael D.; Tumbare, Esther A.; Souda, Sajini; Jao, Jennifer; Wirth, Kathleen E.; Makhema, Joseph; Lockman, Shahin; Fawzi, Wafaie; Essex, Max; Shapiro, Roger L.
• Is Part Of: AIDS. Volume 30:Number 2(2016)
• Publication Date: 2016-01
• Subjects: growth -- HIV-exposed uninfected infants -- in-utero triple antiretrovirals; AIDS (Disease) -- Periodicals; Acquired Immunodeficiency Syndrome; AIDS (Disease); Periodicals; Periodicals; 616.9792005
• DOI: 10.1097/QAD.0000000000000895
• Languages: English
• ISSNs: 0269-9370

Abstract

Abstract : Objective: To assess associations between in-utero triple antiretrovirals (cART) versus zidovudine (ZDV) monotherapy exposure and growth among HIV-uninfected children of HIV-infected women in Botswana. Design: Secondary retrospective data analysis from two randomized intervention trials of mother-to-child HIV transmission prevention. Methods: The Mashi and Mma Bana studies enrolled HIV-infected pregnant women, following their children through 24 months of age. This analysis includes singleton, full-term, HIV-exposed uninfected children. Mothers received cART or ZDV at least 2 weeks predelivery, and breastfed up to 6 months. Weight-for-age (WAZ), length-for-age (LAZ) and weight-for-length (WLZ) z-scores were derived. Mean z-scores were compared by exposure group at 24 months ( t -test, linear regression). Results: Of 819 children, 303 were ZDV- and 516 cART-exposed in utero . Maternal median enrolment CD4 + was higher among ZDV versus cART-treated mothers (393 versus 324 cells/μl; P < 0.0001). Median duration of antepartum antiretroviral use was shorter among ZDV-treated women (5.7 versus 12.0 weeks; P < 0.0001). Median months breastfed were similar (5.9 and 6.0; P = 0.43). At 24 months, mean LAZ and WAZ were significantly lower among cART-exposed children (LAZ –1.01 versus –0.74; P = 0.003) (WAZ –0.53 versus –0.30; P = 0.002) in unadjusted analyses. Adjusting for maternal CD4 +, viral load, enrolment site and maternal anthropometric measures, cART-exposed children had significantly lower LAZ and WAZ at 24 months ( P = 0.0004 for both). Conclusion: At 24 months, in-utero cART-exposed children had significantly lower LAZ and WAZ. Poor growth impacts childhood and adult mortality. These findings raise concerns for potential lasting health impacts among HIV-exposed uninfected children with in-utero cART exposure.