HIV-exposed, uninfected infants in Uganda experience poorer growth and body composition trajectories than HIV-unexposed infants.

Abstract

BACKGROUND HIV-uninfected infants of HIV-positive women may experience worse growth and health outcomes than infants of HIV-negative women, but this has not been thoroughly investigated under the WHO's most recent recommendations to reduce vertical transmission. OBJECTIVE To determine if HIV-exposed and -uninfected (HEU) infants whose mothers received Option B+ have higher odds of experiencing suboptimal growth trajectories than HIV-unexposed, -uninfected infants and if this relationship is affected by food insecurity. DESIGN Repeated anthropometric measures were taken on 238 infants (HEU=86) at 1 week and 1,3,6,9, and 12 months after delivery in Gulu, Uganda. Latent class growth mixture modeling was used to develop trajectories for length-for-age z-scores (LAZ), weight-for-length z-scores, mid-upper arm circumference (MUAC), sum of skinfolds, and arm fat area. Multinomial logistic models were built to predict odds of trajectory class membership, controlling for socioeconomic factors. RESULTS HEU infants had greater odds of being in the shortest two LAZ trajectory classes (OR=3.80[1.22,11.82], OR=8.72 [1.80,42.09]) and higher odds of being in smallest sum of skinfolds trajectory class (OR=3.85[1.39,10.59]) vs. unexposed infants. Among HEU infants, increasing food insecurity was associated with lower odds of being in the lowest sum of skinfolds class (OR=0.86[0.76,0.98]). CONCLUSIONS There continues to be differences in growth patterns by HIV-exposure under the new set of WHO guidelines for the prevention of mother-to-child transmission of HIV and the feeding of HEU infants in low-resource settings that are not readily identified through traditional mixed effects modeling. Food insecurity was not associated with class membership, but differentially affected adiposity by HIV-exposure status.