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Matjuda EN, Engwa GA, Mungamba MM, Sewani-Rusike CR, Goswami N, Nkeh-Chungag BN. Cardio-Metabolic Health of Offspring Exposed in Utero to Human Immuno-Deficiency Virus and Anti-Retroviral Treatment: A Systematic Review. BIOLOGY 2024; 13:32. [PMID: 38248463 PMCID: PMC10813696 DOI: 10.3390/biology13010032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 12/15/2023] [Accepted: 01/02/2024] [Indexed: 01/23/2024]
Abstract
BACKGROUND Antiretroviral treatment (ART) use during pregnancy continues to rise as it is known to decrease the likelihood of HIV transmission from mother to child. However, it is still unknown whether foetal exposure to (ART) may affect the foetal environment, predisposing the offspring to cardiometabolic risk. Therefore, the aim of this study was to systematically review the cardio-metabolic effects of in utero exposure to HIV/ART on offspring. METHODS We carried out a systematic review and obtained literature from the Google scholar, PubMed, ProQuest, Web of Science, and Scopus databases. Two independent reviewers evaluated the titles, abstracts, and full-length English contents. Data from the eligible studies were included. RESULTS The search yielded 7596 records. After assessing all of these records, 35 of the full-length articles were included in this systematic review. Several studies showed that low birth weight, small head circumference, and altered mitochondrial content were more common among HIV-exposed uninfected (HEU) children compared to HIV-unexposed uninfected children (HUU). A few studies demonstrated elevated triglyceride levels, lower levels of insulin, and increased blood pressure, oxidative stress, vascular dysfunction, cardiac damage, and myocardial dysfunction among HEU children compared with HUU children. CONCLUSION Most findings showed that there were cardio-metabolic health risk factors among HEU children, indicating that maternal exposure to HIV and ART may negatively affect foetal health, which may lead to cardio-metabolic morbidity later in life.
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Affiliation(s)
- Edna Ngoakoana Matjuda
- Department of Human Biology, Faculty of Health Sciences, Walter Sisulu University PBX1, Mthatha 5117, South Africa; (E.N.M.); (M.M.M.); (C.R.S.-R.)
| | - Godwill Azeh Engwa
- Department of Biological and Environmental Sciences, Faculty of Health Sciences, Walter Sisulu University PBX1, Mthatha 5117, South Africa; (G.A.E.); (N.G.)
| | - Muhulo Muhau Mungamba
- Department of Human Biology, Faculty of Health Sciences, Walter Sisulu University PBX1, Mthatha 5117, South Africa; (E.N.M.); (M.M.M.); (C.R.S.-R.)
| | - Constance Rufaro Sewani-Rusike
- Department of Human Biology, Faculty of Health Sciences, Walter Sisulu University PBX1, Mthatha 5117, South Africa; (E.N.M.); (M.M.M.); (C.R.S.-R.)
| | - Nandu Goswami
- Department of Biological and Environmental Sciences, Faculty of Health Sciences, Walter Sisulu University PBX1, Mthatha 5117, South Africa; (G.A.E.); (N.G.)
- Physiology Division, Otto Loewi Research Center for Vascular Biology, Immunology and Inflammation, Medical University of Graz, Neue Stiftingtalstrasse 6, D-5 A, 8036 Graz, Austria
- Department of Health Sciences, Alma Mater Europaea, 2000 Maribor, Slovenia
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai P.O. Box 505055, United Arab Emirates
| | - Benedicta Ngwenchi Nkeh-Chungag
- Department of Biological and Environmental Sciences, Faculty of Health Sciences, Walter Sisulu University PBX1, Mthatha 5117, South Africa; (G.A.E.); (N.G.)
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Nlend AEN, Avenec P, Ngoué JE, Sandie AB. Morbidity and Mortality of HIV-Exposed Uninfected Infants in a Tertiary Referral Facility in Yaoundé, Cameroon. Int J MCH AIDS 2023; 12:e663. [PMID: 38312496 PMCID: PMC10753404 DOI: 10.21106/ijma.663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2024] Open
Abstract
Background and Objective Following the recorded progress in the prevention of mother-to-child transmission of HIV in Yaoundé, Cameroon, the proportion of HIV-exposed infants who are uninfected (UIH) is increasing. These children are subject to infectious and non-infectious fragility. The purpose of this study was to assess infectious morbidity and mortality rates among UIH in Yaoundé, Cameroon. Methods We conducted a retrospective cohort study. Infants were included in the study and defined as the study subjects if they were between the ages of 24 months or younger, if they were born to HIV-positive mothers, and if they were confirmed to be HIV-negative. The main study outcomes were morbidity rate (defined as infectious, clinical events that required consultation or hospitalization) and death. Data were entered and saved in the Census and Survey Processing System (Cspro) 7.3. Statistical analyses were performed in R Software 3.6.2. The significance level was set at 0.05. Results In total, 240 subjects were recruited of whom 53.3% were males. Most of the HIV-positive mothers (95.7%) had used combination antiretroviral (ARV) therapy for at least four weeks during pregnancy. Among the subjects, 93.2% received ARV prophylaxis, 68.7% were exclusively breastfed for six months, 94.7% were fully vaccinated, and 60.6% had received cotrimoxazole up to the detection of the non-infection. Overall, the morbidity rate stood at 34.2%. The incidence of morbidity was 3 per 1,000 child months of the follow-up. The main pathologies were acute respiratory infections (60.79%) and malaria (17.65%). Three deaths were recorded, representing an overall mortality rate of 1.25% for an incidence of 1.1 per 1,000 child months of the follow-up (FU). Clinical events were more frequent in mothers diagnosed with HIV during pregnancy under the azidothymidine (AZT) + lamivudine (3TC) + névirapine (NVP) -based protocol (odds ratio of 3.83 [1.09-14.45; p = 0.039]). Morbidity was also higher for the follow-up periods of less than six months. Conclusion and Global Health Implications The overall mortality rate among UIH was low. However, the morbidity rate was considerably higher. Emphasis should be focused on in-care retention for up to 24 months for all UIH, which should include monitoring of HIV-infected mothers prior to pregnancy.
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Affiliation(s)
- Anne E. Njom Nlend
- Essos Hospital Center, National Social Insurance Fund Hospital, Yaoundé, Cameroon and Higher Institute of Medical Technology, University of Douala, Yaoundé, Cameroon
- Higher Institute of Medical Technology, University of Douala, Yaoundé, Cameroon
| | - Pascal Avenec
- Higher Institute of Medical Technology, University of Douala, Yaoundé, Cameroon
| | - Jeannette Epée Ngoué
- Essos Hospital Center, National Social Insurance Fund Hospital, Yaoundé, Cameroon and Higher Institute of Medical Technology, University of Douala, Yaoundé, Cameroon
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
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Mapatha LA, Nakwa FL, Mokhachane M. A comparison of weight gain between HIV exposed uninfected and HIV unexposed uninfected infants who received KMC at Chris Hani Baragwanath Academic Hospital. Front Pediatr 2022; 10:933968. [PMID: 36160783 PMCID: PMC9490005 DOI: 10.3389/fped.2022.933968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 08/19/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Kangaroo Mother Care (KMC) has been associated with improved growth in low birthweight infants and reduction in hypothermia, hypoglycaemia, apnoeas, sepsis, hospital stay, and mortality. The growth of HIV-infected children is poorer than those who are HIV-uninfected. There is paucity of data on weight gain in the HIV-exposed uninfected (HEU) infants compared to HIV-unexposed uninfected (HUU) infants receiving KMC. AIM This study compared the weight gain of HEU and infants HUU from admission to the KMC ward until 12 months corrected age (CA) follow-up visit. METHODS Retrospective record review of the neonates admitted in KMC at Chris Hani Baragwanath Hospital over a 2-year period (2012-2013). The weight gain was assessed via weight velocity using the formula; weight/kg/day from admission to KMC to discharge, and g/ week at term, 3, 6 and 9- and 12-months (CA). The demographics were collected and analyzed using Statistica. RESULTS Seventy-seven (129/166) percent of the mothers were HIV negative. HIV negative mothers were younger (25.9 vs. 31.6 years; p = 0.000) and had fewer pregnancies (p = 0.02). There was no difference between the gestational age (30.3 ± 2.53 vs. 30.8 ± 2.88 weeks; p = 0.35) and birthweight (1,345 g ± 234 vs. 1,314 g ± 209; p = 0.47) between HEU and HUU. There were no differences in the weight gain (23.83 g ± 12.2 vs. 23.22 g ± 15.2; p = 0.83) in KMC. There was no differences in weight gain at the different follow-up time points between the two groups. CONCLUSION Both HEU and HUU groups of infants showed reasonable weight gain despite maternal HIV status.
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Affiliation(s)
- Leshata Abigail Mapatha
- Department of Paediatrics and Child Health, Chris Hani Baragwanath Academic Hospital, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Firdose Lambey Nakwa
- Department of Paediatrics and Child Health, Chris Hani Baragwanath Academic Hospital, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Mantoa Mokhachane
- Unit for Undergraduate Medical Education (UUME), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Sirajee R, Conroy AL, Namasopo S, Opoka RO, Lavoie S, Forgie S, Salami BO, Hawkes MT. Growth Faltering and Developmental Delay in HIV-Exposed Uninfected Ugandan Infants: A Prospective Cohort Study. J Acquir Immune Defic Syndr 2021; 87:730-740. [PMID: 33819206 DOI: 10.1097/qai.0000000000002626] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 12/30/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND HIV-exposed but uninfected (HEU) infants are at increased risk of impaired early linear growth and cognitive development. We examined associations between prenatal and postnatal growth and subsequent neurodevelopment in Ugandan HEU infants, hypothesizing that early insults may explain alterations in both somatic growth and brain development. METHODS We prospectively followed a cohort of HEU infants from birth to 18 months of age, and measured length/height, weight, head, and arm circumference longitudinally. The Malawi Development Assessment Tool (MDAT, 12 and 18 months) and the Color Object Association Test (18 months) were used for developmental assessments. RESULTS Among 170 HEU infants, the prevalence of low-birth weight and failure to thrive was 7.6% and 37%, respectively. HEU infants had MDAT scores that were similar to the reference population. The mean (SD) score on the Color Object Association Test was 5.5 (3.1) compared with 6.9 (5.3) in developmentally normal children. Developmental ability at age 18 months showed strong cross-sectional correlation with weight-for-age (ρ = 0.36, P < 0.0001), length/height-for-age (ρ = 0.41, P < 0.0001), head circumference-for-age (ρ = 0.26, P = 0.0011), and mid-upper arm circumference-for-age (ρ = 0.34, P = 0.0014). There was a statistically significant correlation between birth weight and MDAT z-score at 18 months (ρ = 0.20, P = 0.010). Failure to thrive was associated with lower MDAT z-score [median -0.13 (IQR -0.75 to +0.14) versus +0.14 (IQR -0.44 to +0.63), P = 0.042]. CONCLUSION Growth faltering in HEU infants was associated with lower attainment of developmental milestones at age 18 months. Our findings point to a simple screening method for identifying HEU infants at risk for developmental intervention.
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Affiliation(s)
- Reshma Sirajee
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Andrea L Conroy
- Ryan White Center for Pediatric Infectious Diseases and Global Health, Indiana University School of Medicine, Indianapolis, IN
| | - Sophie Namasopo
- Department of Paediatrics, Jinja Regional Referral Hospital, Jinja, Uganda
| | - Robert O Opoka
- Department of Paediatrics and Child Health, Mulago Hospital and Makerere University, Kampala, Uganda
| | - Stephanie Lavoie
- National Laboratory for HIV Reference Services (NLHRS), National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB, Canada
| | - Sarah Forgie
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Bukola O Salami
- Women and Children's Health Research Institute; and
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Michael T Hawkes
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
- Women and Children's Health Research Institute; and
- Department of Medical Microbiology and Immunology, University of Alberta, Edmonton, AB, Canada
- Department of Global Health, School of Public Health, University of Alberta, Edmonton, AB, Canada
- Distinguished Researcher, Stollery Science Lab
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Ndiaye A, Suneson K, Njuguna I, Ambler G, Hanke T, John-Stewart G, Jaoko W, Reilly M. Growth patterns and their contributing factors among HIV-exposed uninfected infants. MATERNAL AND CHILD NUTRITION 2020; 17:e13110. [PMID: 33269548 PMCID: PMC7988866 DOI: 10.1111/mcn.13110] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 06/11/2020] [Accepted: 10/25/2020] [Indexed: 02/06/2023]
Abstract
With expanded HIV treatment and prevention programmes, most infants born to HIV‐positive women are uninfected, but the patterns and determinants of their growth are not well described. This study aimed to assess growth patterns in a cohort of HIV‐exposed uninfected (HEU) infants who participated in an experimental HIV vaccine trial and to test for associations with maternal and infant factors, including in‐utero exposure to antiretroviral therapy (ART), mode of delivery, exclusive breastfeeding, mother's education and receipt of the vaccine. Infants in the trial were seen at regular clinic visits from birth to 48 weeks of age. From the anthropometric measurements at these visits, weight‐for‐age z‐scores (WAZ), weight‐for‐length z‐scores (WLZ) and length‐for‐age z‐scores (LAZ) were computed using World Health Organization (WHO) software and reference tables. Growth patterns were investigated with respect to maternal and infant factors, using linear mixed regression models. From 94 infants included at birth, growth data were available for 75.5% at 48 weeks. The determinants of infant growth in this population are multifactorial: infant LAZ during the first year was significantly lower among infants delivered by caesarean section (p = 0.043); both WAZ and LAZ were depressed among infants with longer exposure to maternal ART (WAZ: p = 0.015; LAZ: p < 0.0001) and among infants of mothers with lower educational level (WAZ: p = 0.038; LAZ: p < 0.0001); the effect of maternal education was modified by breastfeeding practice, with no differences seen in exclusively breastfed infants. These findings inform intervention strategies to preserve growth in this vulnerable infant population.
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Affiliation(s)
- Aminata Ndiaye
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - Klara Suneson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden.,Faculty of Medicine, Department of Clinical Sciences, Psychiatry, Lund University, Lund, Sweden
| | - Irene Njuguna
- Research and Programs, Kenyatta National Hospital, Nairobi, Kenya.,Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Gwen Ambler
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Tomas Hanke
- Jenner Institute, University of Oxford, Oxford, UK
| | - Grace John-Stewart
- Department of Epidemiology, University of Washington, Seattle, Washington, USA.,Departments of Global Health, Pediatrics, and Medicine, University of Washington, Seattle, Washington, USA
| | - Walter Jaoko
- KAVI-Institute of Clinical Research, University of Nairobi, Nairobi, Kenya
| | - Marie Reilly
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
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Duri K, Gumbo FZ, Munjoma PT, Chandiwana P, Mhandire K, Ziruma A, Macpherson A, Rusakaniko S, Gomo E, Misselwitz B, Mazengera LR. The University of Zimbabwe College of Health Sciences (UZ-CHS) BIRTH COHORT study: rationale, design and methods. BMC Infect Dis 2020; 20:725. [PMID: 33008316 PMCID: PMC7532096 DOI: 10.1186/s12879-020-05432-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 09/21/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Commencing lifelong antiretroviral therapy (ART) immediately following HIV diagnosis (Option B+), has greatly improved maternal-infant health. Thus, large and increasing numbers of HIV-infected women are on ART during pregnancy, a situation concurrently increasing numbers of HIV-exposed-uninfected (HEU) infants. Compared to their HIV-unexposed-uninfected (HUU) counterparts, HEU infants show higher rates of adverse birth outcomes, mortality, infectious/non-communicable diseases including impaired growth and neurocognitive development. There is an urgent need to understand the impact of HIV and early life ART exposures, immune-metabolic dysregulation, comorbidities and environmental confounders on adverse paediatric outcomes. METHODS Six hundred (600) HIV-infected and 600 HIV-uninfected pregnant women ≥20 weeks of gestation will be enrolled from four primary health centres in high density residential areas of Harare. Participants will be followed up as mother-infant-pairs at delivery, week(s) 1, 6, 10, 14, 24, 36, 48, 72 and 96 after birth. Clinical, socio-economic, nutritional and environmental data will be assessed for adverse birth outcomes, impaired growth, immune/neurodevelopment, vertical transmission of HIV, hepatitis-B/C viruses, cytomegalovirus and syphilis. Maternal urine, stool, plasma, cord blood, amniotic fluid, placenta and milk including infant plasma, dried blood spot and stool will be collected at enrolment and follow-up visits. The composite primary endpoint is stillbirth and infant mortality within the first two years of life in HEU versus HUU infants. Maternal mortality in HIV-infected versus -uninfected women is another primary outcome. Secondary endpoints include a range of maternal and infant outcomes. Sub-studies will address maternal stress and malnutrition, maternal-infant latent tuberculosis, Helicobacter pylori infections, immune-metabolomic dysregulation including gut, breast milk and amniotic fluid dysbiosis. DISCUSSION The University of Zimbabwe-College of Health-Sciences-Birth-Cohort study will provide a comprehensive assessment of risk factors and biomarkers for HEU infants' adverse outcomes. This will ultimately help developing strategies to mitigate effects of maternal HIV, early-life ART exposures and comorbidities on infants' mortality and morbidity. TRIAL REGISTRATION ClinicalTrial.gov Identifier: NCT04087239 . Registered 12 September 2019.
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Affiliation(s)
- Kerina Duri
- Department of Immunology, University of Zimbabwe College of Health Sciences (UZ-CHS), P.O. Box A178 Avondale, Harare, Zimbabwe.
| | - Felicity Z Gumbo
- Department of Paediatrics and Child Health, UZ-CHS, Harare, Zimbabwe
| | - Privilege T Munjoma
- Department of Immunology, University of Zimbabwe College of Health Sciences (UZ-CHS), P.O. Box A178 Avondale, Harare, Zimbabwe
| | | | | | - Asaph Ziruma
- Department of Obstetrics and Gynaecology, UZ-CHS, Harare, Zimbabwe
| | - Andrew Macpherson
- Clinic for Visceral Surgery and Medicine, Inselspital Bern and Bern University, Bern, Switzerland
| | | | - Exnevia Gomo
- UZ-CHS Research Support Centre, UZ-CHS, Harare, Zimbabwe
- Department of Medical Laboratory Sciences, UZ-CHS, Harare, Zimbabwe
| | - Benjamin Misselwitz
- Clinic for Visceral Surgery and Medicine, Inselspital Bern and Bern University, Bern, Switzerland
| | - Lovemore Ronald Mazengera
- Department of Immunology, University of Zimbabwe College of Health Sciences (UZ-CHS), P.O. Box A178 Avondale, Harare, Zimbabwe
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Deichsel EL, Pavlinac PB, Richardson BA, Mbori-Ngacha D, Walson JL, McGrath CJ, Farquhar C, Bosire R, Maleche-Obimbo E, John-Stewart GC. Birth size and early pneumonia predict linear growth among HIV-exposed uninfected infants. MATERNAL AND CHILD NUTRITION 2019; 15:e12861. [PMID: 31222958 DOI: 10.1111/mcn.12861] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 06/05/2019] [Accepted: 06/06/2019] [Indexed: 12/27/2022]
Abstract
Stunting remains a global health priority, particularly in sub-Saharan Africa. Identifying determinants of linear growth in HIV-exposed uninfected (HEU) infants can inform interventions to prevent stunting in this vulnerable population. HIV-infected mothers and their uninfected infants were followed monthly from pregnancy to 12-month post-partum in Nairobi, Kenya. Mixed-effects models estimated the change in length-for-age z-score (LAZ) from birth to 12 months by environmental, maternal, and infant characteristics. Multivariable models included factors univariately associated with LAZ. Among 372 HEU infants, mean LAZ decreased from -0.54 (95% confidence interval [CI] [-0.67, -0.41]) to -1.09 (95% CI [-1.23, -0.96]) between 0 and 12 months. Declines in LAZ were associated with crowding (≥2 persons per room; adjusted difference [AD] in 0-12 month change: -0.46; 95% CI [-0.87, -0.05]), use of a pit latrine versus a flush toilet (AD: -0.29; 95% CI [-0.57, -0.02]), and early infant pneumonia (AD: -1.14; 95% CI [-1.99, -0.29]). Infants with low birthweight (<2,500 g; AD: 1.08; 95% CI [0.40, 1.76]) and birth stunting (AD: 1.11; 95% CI [0.45, 1.78]) experienced improved linear growth. By 12 months of age, 46 infants were stunted, of whom 11 (24%) were stunted at birth. Of the 34 infants stunted at birth with an available 12-month LAZ, 68% were not stunted at 12 months. Some low birthweight and birth-stunted HEU infants had significant linear growth recovery. Early infant pneumonia and household environment predicted poor linear growth and may identify a subgroup of HEU infants for whom to provide growth-promoting interventions.
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Affiliation(s)
- Emily L Deichsel
- Biostatistics, Global Health, Epidemiology, Medicine, University of Washington, Seattle, Washington
| | - Patricia B Pavlinac
- Biostatistics, Global Health, Epidemiology, Medicine, University of Washington, Seattle, Washington
| | - Barbra A Richardson
- Biostatistics, Global Health, Epidemiology, Medicine, University of Washington, Seattle, Washington
| | | | - Judd L Walson
- Biostatistics, Global Health, Epidemiology, Medicine, University of Washington, Seattle, Washington.,Child Acute Illness and Nutrition (CHAIN) Network, Nairobi, Kenya
| | - Christine J McGrath
- Biostatistics, Global Health, Epidemiology, Medicine, University of Washington, Seattle, Washington
| | - Carey Farquhar
- Biostatistics, Global Health, Epidemiology, Medicine, University of Washington, Seattle, Washington
| | - Rose Bosire
- Center for Public Health Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | | | - Grace C John-Stewart
- Biostatistics, Global Health, Epidemiology, Medicine, University of Washington, Seattle, Washington
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Penda CI, Tejiokem MC, Sofeu CL, Ndiang ST, Ateba Ndongo F, Kfutwah A, Guemkam G, Warszawski J, Faye A, Study Group TAP. Low rate of early vertical transmission of HIV supports the feasibility of effective implementation of the national PMTCT guidelines in routine practice of referral hospitals in Cameroon. Paediatr Int Child Health 2019; 39:208-215. [PMID: 31017537 DOI: 10.1080/20469047.2019.1585136] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: Vertical (VT) transmission of HIV remains a public health concern in sub-Saharan Africa. Objective: To investigate the VT rate and factors associated with transmission in routine practice in three referral hospitals in Cameroon. Methods: All HIV-infected mothers who delivered in maternity wards or sought paediatric services during the first postnatal week from November 2007 to October 2010 were invited to participate in the ANRS-Pediacam cohort. Their infants were followed at 6, 10 and 14 weeks of life and HIV status was determined from the 6th week of life using real-time PCR. For those who were breastfed and negative at the first PCR, a second test was performed 6 weeks after breast-feeding was stopped. Logistic regression was performed to identify the independent risk factors of VT. Results: Overall, 2053 HIV-exposed infants were enrolled. Of these, 1827 were tested for HIV including 1777 before the age of 3 months, and 59 were HIV-infected, resulting in an overall early VT rate of 3.3% (CI 2.5-4.3). The VT rate was significantly associated with the type of maternal exposure to ART (0.5%, 2/439, p<0.001, CI 0.0-1.6) in mothers who commenced HAART before pregnancy, 1.9% (6/321, CI 0.7-4.0) in mothers who commenced HAART during pregnancy, 4.1% (34/837, CI 2.8-5.6) in those on short-course ART and 11.1% (17/153, CI 6.6-17.2) in mothers not receiving ART. On multivariate analysis, the type of exposure to ART remained significantly associated with being small for gestational age (aOR 5.0, CI 2.4-10.3, p < 0.001) and female gender (aOR 2.1, CI 1.2-3.8, p = 0.01). Conclusion: The successfully low rate of VT transmission of HIV in mothers who commenced HAART in early pregnancy strongly supports the need to improve access to diagnosis and early treatment of all women of childbearing age with HIV through the national PMTCT programme. Abbreviations: ANRS: French National Agency for Research on AIDS and Viral Hepatitis; ART: antiretroviral therapy; ARV: antiretroviral; AUDIPOG: Association des Utilisateurs de Dossiers Informatisés en Pédiatrie, Obstétrique et Gynécologie; CHM/MCC-CBF: The Central Hospital Maternity/Mother and Child Centre of the Chantal Biya Foundation; EHC: Essos Hospital Centre; EPI: Expanded Programme on Immunization; HAART: highly active antiretroviral therapy; HBV: hepatitis B virus; IQR: interquartile range; LH: Laquintinie Hospital; MTCT: mother-to-child transmission; NVP: nevirapine; Pediacam: Pediatrie Cameroun; PMTCT: prevention of mother-to-child transmission; SGAG: small for gestational age and gender; UNAIDS: Joint United Nations Program on HIV/AIDS; WHO: World Health Organization; ZDV: zidovudine; 3TC: lamivudine.
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Affiliation(s)
- Calixte Ida Penda
- a University of Douala, Clinical sciences department, Faculty of Medicine and Pharmaceutical Sci-ences , Douala , Littoral , Cameroon.,b Day Hospital , Laquintinie hospital , Douala , Cameroon
| | - Mathurin Cyrille Tejiokem
- c Service d'Epidémiologie et de Santé Publique, Centre Pasteur du Cameroun , Membre du Réseau International des Instituts Pasteur , Yaoundé , Cameroun
| | - Casimir Ledoux Sofeu
- c Service d'Epidémiologie et de Santé Publique, Centre Pasteur du Cameroun , Membre du Réseau International des Instituts Pasteur , Yaoundé , Cameroun.,d University of Bordeaux, INSERM Bordeaux Population health U1219 (Biostatistic) , Bordeaux , France
| | | | - Francis Ateba Ndongo
- f Central hospital Maternity/Mother -Child Centre , Chantal Biya Foundation , Yaoundé , Cameroon
| | - Anfumbom Kfutwah
- g Service de Virologie, Centre Pasteur du Cameroun , Membre du Réseau International des Instituts Pasteur , Yaoundé , Cameroun.,h WHO country office , Gabon , Libreville
| | - Georgette Guemkam
- f Central hospital Maternity/Mother -Child Centre , Chantal Biya Foundation , Yaoundé , Cameroon
| | - Josiane Warszawski
- i Equipe 4 (VIH et IST) - INSERM U1018 (CESP) , Kremlin Bicêtre , France.,j Assistance Publique des Hôpitaux de Paris, Service d'Epidémiologie et de Santé Publique , Hôpital Kremlin Bicêtre , France.,k Université de Paris Sud 11 , Paris , France
| | - Albert Faye
- l Assistance Publique des Hôpitaux de Paris, Pédiatrie Générale , Hôpital Robert Debré , Paris , France.,m Université Paris 7 Denis Diderot, Sorbonne Paris Cité , Paris , France.,n INSERM UMR 1123 (ECEVE)
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Sofeu CL, Tejiokem MC, Penda CI, Protopopescu C, Ateba Ndongo F, Tetang Ndiang S, Guemkam G, Warszawski J, Faye A, Giorgi R. Early treated HIV-infected children remain at risk of growth retardation during the first five years of life: Results from the ANRS-PEDIACAM cohort in Cameroon. PLoS One 2019; 14:e0219960. [PMID: 31318938 PMCID: PMC6638950 DOI: 10.1371/journal.pone.0219960] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 07/06/2019] [Indexed: 01/17/2023] Open
Abstract
Background Long-term growth in HIV-infected infants treated early in resource-limited settings is poorly documented. Incidence of growth retardation, instantaneous risk of death related to malnutrition and growth parameters evolution during the first five years of life of uninfected and early treated HIV-infected children were compared and associated factors with growth retardation were identified. Methods Weight-for-age (WAZ), weight-for-length (WLZ), and length-for-age (LAZ) Z-scores were calculated. The ANRS-PEDIACAM cohort includes four groups of infants with three enrolled during the first week of life: HIV-infected (HI, n = 69), HIV-exposed uninfected (HEU, n = 205) and HIV-unexposed uninfected (HUU, n = 196). The last group included HIV-infected infants diagnosed before 7 months of age (HIL, n = 141). The multi-state Markov model was used to describe the incidence of growth retardation and identified associated factors. Results During the first 5 years, 27.5% of children experienced underweight (WAZ<-2), 60.4% stunting (LAZ<-2) and 41.1% wasting (WLZ<-2) at least once. The instantaneous risk of death observed from underweight state (35.3 [14.1–88.2], 84.0 [25.5–276.3], and 6.0 [1.5–24.1] per 1000 person-months for 0–6 months, 6–12 months, and 12–60 months respectively) was higher than from non-underweight state (9.6 [5.7–16.1], 20.1 [10.3–39.4] and 0.3 [0.1–0.9] per 1000 person-months). Compared to HEU, HIL and HI children were most at risk of wasting (adjusted HR (aHR) = 4.3 (95%CI: 1.9–9.8), P<0.001 and aHR = 3.3 (95%CI: 1.4–7.9), P = 0.01 respectively) and stunting for HIL (aHR = 8.4 (95%CI: 2.4–29.7). The risk of underweight was higher in HEU compared to HUU children (aHR = 5.0 (CI: 1.4–10.0), P = 0.001). Others associated factors to growth retardation were chronic pathologies, small size at birth, diarrhea and CD4< 25%. Conclusions HIV-infected children remained at high risk of wasting and stunting within the first 5 years period of follow-up. There is a need of identifying suitable nutritional support and best ways to integrate it with cART in pediatric HIV infection global care.
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Affiliation(s)
- Casimir Ledoux Sofeu
- Centre Pasteur du Cameroun, Service d’épidémiologie et de santé publique, Yaoundé, Cameroun
- Aix-Marseille Univiversité, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, France
- Université de Bordeaux, ISPED, INSERM Bordeaux Population health U1219 (Biostatistic), France
- * E-mail:
| | | | - Calixte Ida Penda
- Université de Douala, Faculté de Médecine et de Sciences Pharmaceutiques, Cameroun
- Hôpital de Jour, Hôpital Laquintinie, Douala, Cameroun
| | - Camelia Protopopescu
- Aix-Marseille Univiversité, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, France
| | | | | | - Georgette Guemkam
- Centre Mère et Enfant de la Fondation Chantal Biya, Yaoundé, Cameroun
| | - Josiane Warszawski
- INSERM U1018 (CESP)—Equipe 4 (VIH et IST), Le Kremlin Bicêtre, France
- Assistance Publique des Hôpitaux de Paris, Service d’Epidémiologie et de Santé Publique, Hôpital de Bicêtre, Le Kremlin Bicêtre, France
- Université de Paris Sud 11, Paris, France
| | - Albert Faye
- Assistance Publique des Hôpitaux de Paris, Pédiatrie Générale, Hôpital Robert Debré, Paris, France
- Université Paris 7 Denis Diderot, Paris Sorbonne Cité, Paris, France
- INSERM UMR 1123 (ECEVE), France
| | - Roch Giorgi
- Aix-Marseille Univiversité, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, France
- APHM, Hôpital de la Timone, Service Biostatistique et Technologies de l’Information et de la Communication, Marseille, France
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10
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Lane CE, Bobrow EA, Ndatimana D, Ndayisaba GF, Adair LS. Determinants of growth in HIV-exposed and HIV-uninfected infants in the Kabeho Study. MATERNAL AND CHILD NUTRITION 2019; 15:e12776. [PMID: 30609287 DOI: 10.1111/mcn.12776] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 12/14/2018] [Accepted: 12/20/2018] [Indexed: 01/15/2023]
Abstract
HIV-exposed and HIV-uninfected (HEU) infants may be at increased risk of poor health and growth outcomes. We characterized infant growth trajectories in a cohort of HEU infants to identify factors associated with healthy growth. HIV-positive women participating in prevention of mother-to-child HIV transmission programmes in Kigali, Rwanda, were followed until their infants were 2 years old. Infant anthropometrics were regularly collected. Latent class analysis was used to categorize infant growth trajectories. Multiple logistic regression was used to estimate the odds of infants belonging to each growth trajectory class. On average, this population of HEU infants had moderate linear growth faltering, but only modest faltering in weight, resulting in mean weight-for-length z-score (WLZ) above the World Health Organization (WHO) median. Mean WLZ was 0.53, and mean length-for-age z-score (LAZ) was -1.14 over the first 2 years of life. We identified four unique WLZ trajectories and seven trajectories in LAZ. Low neonatal weight-for-age and a high rate of illness increased the likelihood that infants were in the lightest WLZ class. Shorter mothers were more likely to have infants with linear growth faltering. Female infants who were older at the end of exclusive breastfeeding were more likely to be in the second tallest LAZ class. In conclusion, the current WHO recommendations of Option B+ and extended breastfeeding may induce higher WLZ and lower LAZ early in infancy. However, there is considerable heterogeneity in growth patterns that is obscured by simply analysing average growth trends, necessitating the analysis of growth in subpopulations.
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Affiliation(s)
- Charlotte E Lane
- Nutrition Department, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Emily A Bobrow
- Nutrition Department, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | | | - Linda S Adair
- Nutrition Department, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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11
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Strydom K, Nel DG, Dhansay MA, Van Niekerk E. The effect of maternal HIV status and treatment duration on body composition of HIV-exposed and HIV-unexposed preterm, very and extremely low-birthweight infants. Paediatr Int Child Health 2018; 38:163-174. [PMID: 29790827 DOI: 10.1080/20469047.2018.1466481] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
BACKGROUND There is an evidence gap regarding the relationship between HIV exposure, body composition (and the quality thereof) and preterm infants. AIM This study determined the body composition of HIV-exposed, preterm very low-birthweight (VLBW) and extremely low-birthweight (ELBW) infants and to assess the effect of maternal HAART duration on the body composition of this vulnerable population. METHODS A descriptive cross-sectional study was conducted. HIV-exposed and -unexposed preterm infants (<37 weeks) with a birthweight of ≤1200g were included. Maternal medical background was recorded. Infant body composition measurements were recorded weekly during the 28-day follow-up period. RESULTS Thirty preterm infants (27%) were HIV-exposed. HIV-exposed infants had significantly (=0.01) lower gestational ages than HIV-unexposed infants (25-28 weeks). HIV-exposed infants had significantly lower measurements on day 21 and day 28 for triceps skinfold (TSF) (2.5 mm vs 2.7 mm, = 0.02 and 2.6 mm vs 2.9 mm, <0.01), subscapular skinfold (SSSF) (2.3 mm vs 2.6 mm, = 0.02 and 2.4 mm vs 2.7 mm, =<0.01) and fat mass percentage (FM%) (0.9% vs 1.4%, = 0.02 and 1.0% vs 1.5%, = 0.03). HIV-exposed infants whose mothers received HAART for ≥ 20 weeks were heavier and had a higher FM% and lower fat-free mass percentage (FFM%) at birth than HIV-exposed preterm infants whose mothers received highly active antiretroviral therapy for ≥ 4- < 20 weeks. CONCLUSION Mothers receiving HAART could have increased risk of preterm delivery, and the duration of maternal HAART affects postnatal body composition of their infants. Body composition differs between HIV-exposed and HIV-unexposed preterm infants.
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Key Words
- ANOVA, analysis of variance
- ART, antiretroviral therapy
- AZT, zidovudine
- Body composition
- CVD, cardiovascular diseases
- DRC, Democratic Republic of Congo
- ELBW, extremely low birthweight
- FFM%, fat-free mass percentage
- FFM, fat-free mass
- FM%, fat mass percentage
- FM, fat mass
- GA, gestational age
- HAART duration
- HAART, highly active antiretroviral therapy
- HIC, high-income countries
- HIV-exposed
- HIV-unexposed
- IUGR, intrauterine growth restriction
- LBW, low birthweight
- LGA, large for gestational age
- LMIC, low- and middle-income countries
- MCT, medium-chain triglycerides
- MTCT, mother-to-child transmission
- NCPAP, nasal continuous positive airway pressure
- NHANES, National Health and Nutrition Examination Survey
- NICU, neonatal Intensive Care Unit
- NVP, nevirapine
- PCR, polymerase chain reaction
- PMTCT, prevention of mother-to-child transmission
- SAPMTCTE, South African prevention of mother-to-child transmission evaluation
- SFT, skinfold thickness
- SGA, small for gestational age
- SSSF, subscapular skinfold
- TAH, Tygerberg Academic Hospital
- TBCH, Tygerberg Children’s Hospital
- TEA, term equivalent age
- TSF, triceps skinfold
- USA, United States of America
- VLBW, very low birthweight
- fat mass
- fat-free mass
- preterm infant
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Affiliation(s)
- Klara Strydom
- a Faculty of Medicine and Health Sciences, Division of Human Nutrition , Stellenbosch University , Cape Town , South Africa
| | - Daniel Gerhardus Nel
- d Department of Statistics and Actuarial Sciences , Stellenbosch University , Tygerberg , South Africa
| | - Muhammad Ali Dhansay
- a Faculty of Medicine and Health Sciences, Division of Human Nutrition , Stellenbosch University , Cape Town , South Africa.,b South African Medical Research Council, Burden of Disease Research Unit , Cape Town , South Africa.,c Faculty of Medicine and Health Sciences, Department of Paediatrics and Child Health , Stellenbosch University , Cape Town , South Africa
| | - Evette Van Niekerk
- a Faculty of Medicine and Health Sciences, Division of Human Nutrition , Stellenbosch University , Cape Town , South Africa
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12
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Dara JS, Hanna DB, Anastos K, Wright R, Herold BC. Low Birth Weight in Human Immunodeficiency Virus-Exposed Uninfected Infants in Bronx, New York. J Pediatric Infect Dis Soc 2018; 7:e24-e29. [PMID: 29301007 PMCID: PMC5954301 DOI: 10.1093/jpids/pix111] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 11/30/2017] [Indexed: 01/01/2023]
Abstract
BACKGROUND Prevention of mother-to-child transmission of human immunodeficiency virus (HIV) with antiretroviral therapy (ART) has been highly successful. However, HIV-exposed uninfected (HIV-EU) infants might be at increased risk for low birth weight and/or preterm birth. We compared the birth weights and gestational ages of HIV-EU infants to those of HIV-unexposed control infants in Bronx, New York, an epicenter of the HIV epidemic in the United States. METHODS This study was performed with a retrospective cohort of HIV-EU infants born at Montefiore Medical Center between 2008 and 2012 and HIV-unexposed control infants. Each HIV-EU infant was matched according to year of birth with 5 HIV-unexposed controls from the New York City Department of Health and Mental Hygiene birth certificate database. We used regression models to assess the association between HIV exposure and birth weight while controlling for potential confounders. A secondary analysis was performed to determine the association of maternal protease inhibitor-based ART use and birth weight among HIV-EU infants. RESULTS We included 155 HIV-EU infants born between 2008 and 2012 (51% female, 61% black, 32% Hispanic) and 775 HIV-unexposed infants. The mean (± standard deviation) unadjusted birth weights were 2971 ± 616 g (HIV-EU infants) and 3163 ± 644 g (HIV-unexposed infants) (P < .01). Multivariable regression revealed significantly lower birth weight for the HIV-EU infants (difference, -101.5 g [95% confidence interval, -181.4 to -21.6]). We found no difference in mean birth weight or gestational age with maternal protease inhibitor-based ART use when compared to the use of other regimens. CONCLUSIONS We found significantly lower birth weight among HIV-EU infants. Long-term prospective studies are necessary to determine the implications of this finding on infant growth and development.
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Affiliation(s)
- Jasmeen S Dara
- Department of Pediatrics, Montefiore Medical Center, Bronx, New York,Correspondence: J. S. Dara, MD, University of California, San Francisco, Benioff Children’s Hospital, Department of Pediatrics, Division of Pediatric Allergy and Immunology, Mission Hall, 4th Floor, 550 16th St, Box 0434, San Francisco, CA ()
| | - David B Hanna
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Kathryn Anastos
- Department of Medicine, Montefiore Medical Center, Bronx, New York,Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Rodney Wright
- Department of Obstetrics and Gynecology, Montefiore Medical Center, Bronx, New York
| | - Betsy C Herold
- Department of Pediatrics, Montefiore Medical Center, Bronx, New York
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13
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Schoeman JC, Moutloatse GP, Harms AC, Vreeken RJ, Scherpbier HJ, Van Leeuwen L, Kuijpers TW, Reinecke CJ, Berger R, Hankemeier T, Bunders MJ. Fetal Metabolic Stress Disrupts Immune Homeostasis and Induces Proinflammatory Responses in Human Immunodeficiency Virus Type 1- and Combination Antiretroviral Therapy-Exposed Infants. J Infect Dis 2017. [PMID: 28633455 PMCID: PMC5853663 DOI: 10.1093/infdis/jix291] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Increased morbidity and fetal growth restriction are reported in uninfected children born to human immunodeficiency virus type 1 (HIV-1)-infected women treated with antiretroviral (ARV) therapy. Viruses and/or pharmacological interventions such as ARVs can induce metabolic stress, skewing the cell's immune response and restricting (cell) growth. Novel metabolomic techniques provided the opportunity to investigate the impact of fetal HIV-1 and combination ARV therapy (cART) exposure on the infants' immune metabolome. Peroxidized lipids, generated by reactive oxygen species, were increased in cART/HIV-1-exposed infants, indicating altered mitochondrial functioning. The lipid metabolism was further dysregulated with increased triglyceride species and a subsequent decrease in phospholipids in cART/HIV-1-exposed infants compared to control infants. Proinflammatory immune mediators, lysophospholipids as well as cytokines such as CXCL10 and CCL3, were increased whereas anti-inflammatory metabolites from the cytochrome P450 pathway were reduced in cART/HIV-1-exposed infants. Taken together, these data demonstrate that the fetal metabolism is impacted by maternal factors (cART and HIV-1) and skews physiological immune responses toward inflammation in the newborn infant.
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Affiliation(s)
- Johannes C Schoeman
- Department of Analytical Biosciences, Leiden Academic Center for Drug Research, Leiden University, The Netherlands
| | - Gontse P Moutloatse
- Centre for Human Metabolomics, Faculty of Natural Sciences, North-West University, Potchefstroom, South Africa
| | - Amy C Harms
- Department of Analytical Biosciences, Leiden Academic Center for Drug Research, Leiden University, The Netherlands
| | - Rob J Vreeken
- Department of Analytical Biosciences, Leiden Academic Center for Drug Research, Leiden University, The Netherlands
| | - Henriette J Scherpbier
- Department of Pediatric Hematology, Immunology and Infectious Diseases, Emma Children's Hospital
| | | | - Taco W Kuijpers
- Department of Pediatric Hematology, Immunology and Infectious Diseases, Emma Children's Hospital
| | - Carools J Reinecke
- Centre for Human Metabolomics, Faculty of Natural Sciences, North-West University, Potchefstroom, South Africa
| | - Ruud Berger
- Department of Analytical Biosciences, Leiden Academic Center for Drug Research, Leiden University, The Netherlands
| | - Thomas Hankemeier
- Department of Analytical Biosciences, Leiden Academic Center for Drug Research, Leiden University, The Netherlands
| | - Madeleine J Bunders
- Department of Experimental Immunology.,Emma Children's Hospital, Academic Medical Center, University of Amsterdam, The Netherlands.,Research Unit Virus Immunology, Heinrich-Pette-Institute, Hamburg, Germany
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14
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Abstract
BACKGROUND Growth failure is common among HIV-infected infants, but there are limited data on the effects of HIV exposure or timing of HIV acquisition on growth. METHODS Fourteen thousand one hundred ten infants were enrolled in the Zimbabwe Vitamin A for Mothers and Babies trial in Zimbabwe before the availability of antiretroviral therapy or co-trimoxazole. Anthropometric measurements were taken from birth through 12-24 months of age. Growth outcomes were compared between 5 groups of children: HIV-infected in utero (IU), intrapartum (IP) or postnatally (PN); HIV-exposed uninfected (HEU); and HIV unexposed. RESULTS Growth failure was common across all groups of children. Compared with HIV-unexposed children, IU-, IP- and PN-infected children had significantly lower length-for-age and weight-for-length Z scores throughout the first 2 years of life. At 12 months, odds ratios for stunting were higher in IU [6.25, 95% confidence interval (CI): 4.20-9.31] and IP infants (4.76, 95% CI: 3.58-6.33) than in PN infants (1.70, 95% CI: 1.16-2.47). Compared with HIV-unexposed infants, HEU infants at 12 months had odds ratios for stunting of 1.23 (95% CI: 1.08-1.39) and wasting of 1.56 (95% CI: 1.22-2.00). CONCLUSIONS HIV-infected infants had very high rates of growth failure during the first 2 years of life, particularly if IU or IP infected, highlighting the importance of early infant diagnosis and antiretroviral therapy. HEU infants had poorer growth than HIV-unexposed infants in the first 12 months of life.
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15
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Oddo VM, Christian P, Katz J, Liu L, Kozuki N, Black RE, Ntozini R, Humphrey J. Stunting Mediates the Association between Small-for-Gestational-Age and Postneonatal Mortality. J Nutr 2016; 146:2383-2387. [PMID: 27733526 PMCID: PMC5086790 DOI: 10.3945/jn.116.235457] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 09/09/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND In sub-Saharan Africa, one-third of all births are small for gestational age (SGA), and 4.4 million children are stunted; both conditions increase the risk of child mortality. SGA has also been shown to increase the risk of stunting. OBJECTIVE We tested whether the association between SGA and postneonatal mortality is mediated by stunting. METHODS We used longitudinal data from children aged 6 wk to 24 mo (n = 12,155) enrolled in the ZVITAMBO (Zimbabwe Vitamin A for Mothers and Babies) trial. HIV exposure was defined based on maternal HIV status at baseline. SGA was defined as birthweight <10th percentile of the INTERGROWTH-21st (International Fetal and Newborn Growth Consortium for the 21st Century) standards. We used a standard mediation approach by comparing the attenuation of the risk when the mediator was added to the model. We used Cox proportional hazards models first to regress SGA on postneonatal mortality, controlling for age. Stunting (length-for-age z score <-2) was then included in the model to test mediation. RESULTS Approximately 20% of children were term SGA, and 23% were stunted before their last follow-up visit. In this cohort, 31% of children were exposed to HIV; the HIV-exposed group represented a pooled group of HIV-infected and HIV-exposed but uninfected children. Postneonatal mortality was significantly higher among children born SGA (HR: 1.5; 95% CI: 1.3, 1.7). This association was attenuated and not statistically significant when stunting was included in the model, suggesting a mediation effect (HR: 1.1; 95% CI: 0.91, 1.3). When stratified by HIV exposure status, we observed a significant attenuation of the risk, suggesting mediation, only among HIV-exposed children (model 1, HR: 1.3; 95% CI: 1.1, 1.6; model 2, HR: 1.1; 95% CI: 0.88, 1.3). CONCLUSIONS This analysis aids in investigating pathways that underlie an observed SGA-mortality relation and may inform survival interventions in undernourished settings.
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Affiliation(s)
| | - Parul Christian
- Departments of International Health and,Bill & Melinda Gates Foundation, Seattle, WA; and
| | | | - Li Liu
- Departments of International Health and,Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | | | | | - Robert Ntozini
- ZVITAMBO Institute for Maternal and Child Health Research, Harare, Zimbabwe
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16
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Slogrove AL, Goetghebuer T, Cotton MF, Singer J, Bettinger JA. Pattern of Infectious Morbidity in HIV-Exposed Uninfected Infants and Children. Front Immunol 2016; 7:164. [PMID: 27199989 PMCID: PMC4858536 DOI: 10.3389/fimmu.2016.00164] [Citation(s) in RCA: 104] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 04/18/2016] [Indexed: 11/13/2022] Open
Abstract
Background Almost 30% of children in Southern Africa are HIV exposed but uninfected (HEU) and experience exposures that could increase vulnerability to infectious diseases compared to HIV unexposed (HU) children. The mechanisms of HEU infant vulnerability remain ill-defined. This review seeks to appraise the existing clinical evidence of the pattern of HEU infant infectious morbidity to aid understanding of the potential mechanism of susceptibility. Methods A systematic search was conducted of scientific literature databases and conference proceedings up to December 2015 for studies comparing adequately defined HEU (in whom HIV-infection had been excluded through age-appropriate testing) and HU infants for all-cause mortality, all-cause hospitalization, or an infection-related morbidity. The systematic review was complemented by a narrative review of additional studies detailing the pattern of infectious morbidity experienced by HEU children without comparison to HU children or without conclusive exclusion of HIV-infection in HIV-exposed infants. Results Only 3 of 22 eligible identified studies were designed to primarily compare HEU and HU infants for infectious morbidity. Fourteen were conducted prior to 2009 in the context of limited antiretroviral interventions. Three patterns emerge: (1) causes of morbidity and mortality in HEU infants are consistent with the common causes of childhood morbidity and mortality (pneumonia, diarrheal disease, and bacterial sepsis) but occur with greater severity in HEU infants resulting in higher mortality, more frequent hospitalization, and more severe manifestations of disease; (2) the greatest relative difference between HEU and HU infants in morbidity and mortality occurs beyond the neonatal period, during mid-infancy, having waned by the second year of life; and (3) HEU infants are at greater risk than HU infants for invasive streptococcal infections specifically Group B Streptococcus and Streptococcus pneumonia. Conclusion To definitively understand HEU infant infectious morbidity risk, substantially larger prospective studies with appropriate HU infant comparison groups are necessary. HEU children would benefit from collaboration among researchers to achieve the quality of evidence required to improve HEU infant outcomes globally. HEU infant health and well-being, beyond avoiding HIV-infection, deserves a more prominent position in the local and international HIV research agendas.
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Affiliation(s)
- Amy L Slogrove
- Division of Paediatric Infectious Diseases, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa; School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Tessa Goetghebuer
- Department of Paediatrics, St Pierre University Hospital, Brussels, Belgium; Université Libre de Bruxelles, Brussels, Belgium
| | - Mark F Cotton
- Division of Paediatric Infectious Diseases, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University , Tygerberg , South Africa
| | - Joel Singer
- School of Population and Public Health, University of British Columbia , Vancouver, BC , Canada
| | - Julie A Bettinger
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Vaccine Evaluation Center, BC Children's Hospital, University of British Columbia , Vancouver, BC , Canada
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17
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Altan AMD, Taafo F, Fopa F, Buonomo E, Marazzi MC, Nielsen-Saines K, Orlando S, Scarcella P, Ciccacci F, Mancinelli S, Lio MMS, Palombi L. An assessment of option B implementation for the prevention of mother to child transmission in Dschang, Cameroon: results from the DREAM (Drug Resource Enhancement against AIDS and Malnutrition) cohort. Pan Afr Med J 2016; 23:72. [PMID: 27217896 PMCID: PMC4862786 DOI: 10.11604/pamj.2016.23.72.7958] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 02/27/2016] [Indexed: 11/12/2022] Open
Abstract
Introduction Scaling up of antiretroviral therapy (ART) to HIV+ pregnant women is crucial for the elimination of HIV infection in children. The aim of this study was to evaluate the feasibility and effectiveness of triple ART for Prevention of Mother-to Child Transmission (PMTCT) in Cameroon. Methods HIV-positive pregnant women attending the DREAM Centre of Dschang, Cameroon for prenatal care were enrolled in a prospective cohort study, and received ART until the end of breastfeeding or indefinitely if their CD4 count was <350mm3. Infants were evaluated for HIV infection at 1, 6 and 12 months of age. Results A total of 298 women were enrolled. Among them, 152 were already on established ART. Women were followed until 6 months after delivery with a retention rate of 92.6%. Eight women died. Those with a CD4 count <350 cells/mm3 during pregnancy had the highest mortality risk (RR 2.53; 95% CL= 1.86-3.44). The HIV transmission rate was 1.2% at 12 months with an HIV free survival of 91%. In the proportional Cox regression analysis, the following factors were positively associated with infant mortality: maternal CD4< 350 cells/mm3, no breastfeeding in the first 6 months of life, weight-for-age z score<-2. Conclusion Results confirm the feasibility and effectiveness of the implementation of Option B, with very low rates of HIV MTC transmission, and potential benefits to the health of mothers and infants with earlier initiation of ART. Breastfeeding again demonstrates to be highly beneficial for the growth and survival of HIV exposed children.
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Affiliation(s)
| | | | | | - Ersilia Buonomo
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Italy
| | | | - Karin Nielsen-Saines
- Department of Pediatrics, David Geffen UCLA School of Medicine, Los Angeles, California
| | | | - Paola Scarcella
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Italy
| | | | - Sandro Mancinelli
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Italy
| | | | - Leonardo Palombi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Italy
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18
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Sidze LK, Faye A, Tetang SN, Penda I, Guemkam G, Ateba FN, Ndongo JA, Nguefack F, Texier G, Tchendjou P, Kfutwah A, Warszawski J, Tejiokem MC. Different factors associated with loss to follow-up of infants born to HIV-infected or uninfected mothers: observations from the ANRS 12140-PEDIACAM study in Cameroon. BMC Public Health 2015; 15:228. [PMID: 25886161 PMCID: PMC4358721 DOI: 10.1186/s12889-015-1555-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2014] [Accepted: 02/16/2015] [Indexed: 11/23/2022] Open
Abstract
Background Loss to follow-up (LTFU) is a cause of potential bias in clinical studies. Differing LTFU between study groups may affect internal validity and generalizability of the results. Understanding reasons for LTFU could help improve follow-up in clinical studies and thereby contribute to goals for prevention, treatment, or research being achieved. We explored factors associated with LTFU of mother-child pairs after inclusion in the ANRS 12140-Pediacam study. Methods From November 2007 to October 2010, 4104 infants including 2053 born to HIV-infected mothers and 2051 born to HIV-uninfected mothers matched individually on gender and study site were enrolled during the first week of life in three referral hospitals in Cameroon and scheduled for visits at 6, 10 and 14 weeks of age. Visits were designated 1, 2 and 3, in chronological order, irrespective of the child’s age at the time of the visit. Mother-child pairs were considered lost to follow-up if they never returned for a clinical visit within the first six months after inclusion. Uni- and multivariable logistic regression were adjusted on matching variables to identify factors associated with LTFU according to maternal HIV status. Results LTFU among HIV-unexposed infants was four times higher than among HIV-exposed infants (36.7% vs 9.8%, p < 0.001). Emergency caesarean section (adjusted Odds Ratio (aOR) = 2.46 95% Confidence Interval (CI) [1.47-4.13]), young maternal age (aOR = 2.29, 95% CI [1.18-4.46]), and absence of antiretroviral treatment for prophylaxis (aOR = 3.45, 95% CI [2.30-5.19]) were independently associated with LTFU among HIV-exposed infants. Factors associated with LTFU among HIV-unexposed infants included young maternal age (aOR = 1.96, 95% CI [1.36-2.81]), low maternal education level (aOR = 2.77, 95% CI [1.95-3.95]) and housewife/unemployed mothers (aOR = 1.56, 95% CI [1.16-2.11]). Conclusion Failure to return for at least one scheduled clinical visit is a problem especially among HIV-unexposed infants included in studies involving HIV-exposed infants. Factors associated with this type of LTFU included maternal characteristics, socio-economic status, quality of antenatal care and obstetrical context of delivery. Enhanced counselling in antenatal and intrapartum services is required for mothers at high risk of failure to return for follow-up visits. Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-1555-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Larissa Kamgue Sidze
- Service d'Epidémiologie et de Santé Publique, Centre Pasteur du Cameroun, Membre du Réseau International des Instituts Pasteur, Yaoundé, Cameroun. .,ISPED, Université Victor Segalen, Bordeaux II, France.
| | - Albert Faye
- Assistance Publique des Hôpitaux de Paris, Pédiatrie Générale, Hôpital Robert Debré, Paris, France. .,Université Paris 7 Denis Diderot, Paris Sorbonne Cité, Paris, France.
| | | | - Ida Penda
- Hôpital de Jour, Hôpital Laquintinie, Douala, Cameroun. .,Faculté de Médecine et des Sciences Pharmaceutiques, Université de Douala, Douala, Cameroun.
| | - Georgette Guemkam
- Centre Mère et Enfant de la Fondation Chantal Biya, Yaoundé, Cameroun.
| | | | | | - Félicité Nguefack
- Centre Mère et Enfant de la Fondation Chantal Biya, Yaoundé, Cameroun. .,Faculté de Médecine et des Sciences Biomédicales, Université de Yaoundé I, Yaoundé, Cameroun.
| | - Gaëtan Texier
- Service d'Epidémiologie et de Santé Publique, Centre Pasteur du Cameroun, Membre du Réseau International des Instituts Pasteur, Yaoundé, Cameroun. .,SESSTIM (UMR 912), Université Aix-Marseille, Marseille, France.
| | - Patrice Tchendjou
- Service d'Epidémiologie et de Santé Publique, Centre Pasteur du Cameroun, Membre du Réseau International des Instituts Pasteur, Yaoundé, Cameroun. .,ISPED, Université Victor Segalen, Bordeaux II, France.
| | - Anfumbom Kfutwah
- Service de Virologie, Centre Pasteur du Cameroun, Membre du Réseau International des Instituts Pasteur, Yaoundé, Cameroun.
| | - Josiane Warszawski
- Equipe 4 (VIH et IST) - INSERM U1018 (CESP), Le Kremlin Bicêtre, Paris, France. .,Assistance Publique des Hôpitaux de Paris, Service d'Epidémiologie et de Santé Publique, Hôpital de Bicêtre, Le Kremlin Bicêtre, Paris, France. .,Université de Paris Sud 11, Paris, France.
| | - Mathurin Cyrille Tejiokem
- Service d'Epidémiologie et de Santé Publique, Centre Pasteur du Cameroun, Membre du Réseau International des Instituts Pasteur, Yaoundé, Cameroun. .,Equipe 4 (VIH et IST) - INSERM U1018 (CESP), Le Kremlin Bicêtre, Paris, France.
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