Growth and body composition of adolescents and young adults exposed to HIV and antiretroviral therapy in utero: a systematic review and meta-analysis

Abstract

Introduction: Antiretroviral therapy (ART) is a highly effective measure to prevent mother-to-child transmission of the human immunodeficiency virus (HIV) and to decline mortality allowing children to reach adolescence and adulthood. However, studies evaluating in utero exposure to HIV/ART and adolescent growth are scarce. Thus, this study aims to summarize the evidence of observational studies about the growth and body composition of adolescents and young adults exposed to HIV and ART in utero. Methods: We conducted a systematic review using PubMed/MEDLINE, CENTRAL, Lilacs, EMBASE, CINAHL, and Web of Science databases. We included cohort studies that evaluated adolescents and young adults who were exposed to HIV and ART in utero. A meta-analysis was conducted to estimate the prevalence of low height-for-age (HAZ) and low BMI-for-age (BAZ). Also, meta-analyses for the mean values of HAZ and BAZ in the population after the follow-up period and for the mean change of HAZ and BAZ after the follow-up were conducted. Results: In total, twelve studies were included in this systematic review, 11 of those evaluated adolescents with perinatally acquired HIV. We estimated a prevalence of low HAZ of 26% (P = 0.26; 95%CI 95% CI 0.23–0.29) and low BAZ of 7% (P = 0.07; 95%CI95% CI 0.05–0.09). In this population, the mean value of HAZ was − 1.58 (95%CI95% CI -1.90; -1.27), and that for the BAZ was − 0.44 (95%CI95% CI -0.67; -0.21). We also identified an increase of 0.55 (MD: 0.55, 95% CI: 0.07;1.03) and 0.12 (MD: 0.12, 95% CI: -0.75; 0.99) in the mean values of the HAZ and BAZ, respectively, after the follow-up period. Discussion: Adolescents exposed to HIV/ART in utero continue to fail to thrive. However, BAZ found mean values within the normal limits recommended by the WHO, demonstrating that although delayed weight gain is common among adolescents with prenatally acquired HIV, BMI is less affected. Conclusions: Adolescents exposed to HIV/ART in utero continue to fail to thrive. However, the limited number of studies and their limitations have restricted the ability to draw consistent conclusions about the effect and magnitude of the exposure on anthropometric outcomes. Further studies are needed to better describe these relationships. PROSPERO Number: CRD42022372837