Child Growth According to Maternal and Child HIV Status in Zimbabwe

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.

FIGURE 1.

Mean length-for-age (A) and weight-for-length (B) Z scores from birth to 24 months according to child HIV status and timing of infection. A: N for IU at baseline, 6 weeks, 6, 12, 18 and 24 months is 380, 264, 142, 103, 52 and 34, respectively. N for IP at 6 weeks, 6, 12, 18 and 24 months is 502, 284, 200, 102 and 57, respectively. N for PN at 6, 12, 18 and 24 months is 77, 138, 97 and 80, respectively. N for HEU at baseline, 6 weeks, 6, 12, 18 and 24 months is 3993, 2365, 2181, 1916, 1007 and 714, respectively. N for unexposed at baseline, 6 weeks, 6, 12, 18 and 24 months is 9053, 6233, 6439, 6212, 1733 and 1220, respectively. B: N for IU at baseline, 6 weeks, 6, 12, 18 and 24 months is 342, 262, 142, 103, 52 and 34, respectively. N for IP at 6 weeks, 6, 12, 18 and 24 months is 449, 498, 282, 199, 102 and 56, respectively. N for PN at 6, 12, 18 and 24 months is 77, 138, 96 and 79, respectively. N for HEU at baseline, 6 weeks, 6, 12, 18 and 24 months is 3730, 2346, 2177, 1915, 1006 and 710, respectively. N for unexposed at baseline, 6 weeks, 6, 12, 18 and 24 months is 8598, 6206, 6431, 6202, 1733 and 1216, respectively.