TY - JOUR
T1 - Growth patterns among HIV-exposed infants receiving nevirapine prophylaxis in Pune, India
AU - Ram, Malathi
AU - Gupte, Nikhil
AU - Nayak, Uma
AU - Kinikar, Aarti A.
AU - Khandave, Mangesh
AU - Shankar, Anita V.
AU - Sastry, Jayagowri
AU - Bollinger, Robert C.
AU - Gupta, Amita
N1 - Funding Information:
This study was supported by the US National Institutes of Health (NIH), US National Institute of Allergy and Infectious Diseases (NIAID) Grant R01A145462, and the Fogarty International Center NIH Program of International Training Grants in Epidemiology Related to AIDS (D43-TW000010-22). AG, NG, AS, JG, and RCB have also been supported by the NIH, NIAID BJMC HIV Clinical Trials Unit (U01A1069497).
PY - 2012/10/31
Y1 - 2012/10/31
N2 - 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.
AB - 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.
KW - Extended use of nevirapine
KW - Growth patterns
KW - HIV-exposed infants
KW - India
KW - Risk factors
KW - Timing of HIV Infection
UR - http://www.scopus.com/inward/record.url?scp=84868225521&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84868225521&partnerID=8YFLogxK
U2 - 10.1186/1471-2334-12-282
DO - 10.1186/1471-2334-12-282
M3 - Article
C2 - 23114104
AN - SCOPUS:84868225521
SN - 1471-2334
VL - 12
JO - BMC infectious diseases
JF - BMC infectious diseases
M1 - 282
ER -