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

Malathi Ram, Nikhil Gupte, Uma Nayak, Aarti A Kinikar, Mangesh Khandave, Anita V Shankar, Jayagowri Sastry, Robert C Bollinger, Amita Gupta, SWEN India and BJMC-JHU Clinical Trials Study Team, Malathi Ram, Nikhil Gupte, Uma Nayak, Aarti A Kinikar, Mangesh Khandave, Anita V Shankar, Jayagowri Sastry, Robert C Bollinger, Amita Gupta, SWEN India and BJMC-JHU Clinical Trials Study Team

Abstract

Background: India 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.

Methods: We 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.

Results: Among 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.

Conclusion: Baseline 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 registration: NCT00061321.

Figures

Figure 1
Figure 1
Mean Length -for-Age Z Scores by Infant HIV Status (Stunting).
Figure 2
Figure 2
Mean Weight-for-Age Z Scores by Infant HIV Status (Underweight).
Figure 3
Figure 3
Mean Weight-for-Length Z Scores by Infant HIV Status (Wasting).
Figure 4
Figure 4
Mean Length -for-Age Z Scores by Timing of HIV Transmission (Stunting).
Figure 5
Figure 5
Mean Weight -for-Age Z Scores by Timing of HIV Transmission (Underweight).
Figure 6
Figure 6
Mean Weight -for-Length Z Scores by Timing of HIV Transmission (Wasting).
Figure 7
Figure 7
Mean Length-for-Age Z Scores by SWEN Arm and Infant HIV Status (Stunting).
Figure 8
Figure 8
Mean Weight-for-Age Z Scores by SWEN Arm and Infant HIV Status (Underweight).
Figure 9
Figure 9
Mean Weight-for-Length Z Scores by SWEN Arm and Infant HIV Status (Wasting).

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