Higher prevalence of stunting and poor growth outcomes in HIV-exposed uninfected than HIV-unexposed infants in Kenya

• Published in: AIDS (London) Vol. 36; no. 4; pp. 605 - 610
• Main Authors: Neary, Jillian, Langat, Agnes, Singa, Benson, Kinuthia, John, Itindi, Janet, Nyaboe, Edward, Ng’anga’, Lucy W., Katana, Abraham, John-Stewart, Grace C., McGrath, Christine J.
• Format: Journal Article
• Language: English
• Published: England Lippincott Williams & Wilkins 15-03-2022
• Subjects: Child; Female; Growth Disorders - epidemiology; HIV Infections - complications; HIV Infections - drug therapy; HIV Infections - epidemiology; Humans; Infant; Kenya - epidemiology; Microcephaly; Pregnancy; Pregnancy Complications, Infectious - drug therapy; Prevalence; Prospective Studies; Kenya
• ISSN: 0269-9370; 1473-5571
• DOI: 10.1097/QAD.0000000000003124

With the growing population of HIV-exposed uninfected (HEU) children globally, it is important to determine population-level growth differences between HEU and HIV-unexposed uninfected (HUU) children.
We analyzed data from a population-level survey enrolling mother-infant pairs attending 6-week and 9-month immunizations in 140 clinics across Kenya. Weight-for-age (WAZ), length-for-age (LAZ), head circumference-for-age (HCAZ) z-scores and underweight (WAZ < -2), stunting (LAZ < -2), and microcephaly (HCAZ < -2), were compared between HEU and HUU. Correlates of growth faltering and poor growth were assessed using generalized Poisson and linear regression models.
Among 2457 infants, 456 (19%) were HEU. Among mothers living with HIV, 64% received antiretroviral therapy (ART) and 22% were on antiretroviral prophylaxis during pregnancy. At 9 months, 72% of HEU and 98% of HUU were breastfeeding. At 6 weeks, HEU had lower mean WAZ (-0.41 vs. -0.09; P < 0.001) and LAZ (-0.99 vs. -0.31; P = 0.001) than HUU. Stunting was higher in HEU than HUU at 6 weeks (34% vs. 18%, P < 0.001) and 9 months (20% vs. 10%, P < 0.001). In multivariable analyses, HEU had lower mean LAZ at 6 weeks (-0.67, 95% confidence interval [CI]: -1.07, -0.26) and 9 months (-0.57, 95% CI: -0.92, -0.21) and HEU had higher stunting prevalence (week-6 adjusted prevalence ratio [aPR]: 1.88, 95% CI: 1.35, 2.63; month-9 aPR: 2.10, 95% CI: 1.41, 3.13). HEU had lower mean head circumference (-0.49, 95% CI: -0.91, -0.07) and higher prevalence of microcephaly (aPR: 2.21, 95% CI: 1.11, 4.41) at 9 months.
Despite high maternal ART coverage, HEU had poorer growth than HUU in this large population-level comparison. Optimizing breastfeeding practices in HEU may be useful to improve growth.