Impact of HIV Exposure on Health Outcomes in HIV-Negative Infants Born to HIV-Positive Mothers in Sub-Saharan Africa

Moraleda, Cinta; Deus, Nilsa de; Serna-Bolea, Cèlia; Renom, Montse; Quintó, Llorenç; Macete, Eusébio; Menéndez, Clara; Naniche, Denise

doi:10.1097/qai.0000000000000019

Cited by 41 publications

(57 citation statements)

References 39 publications

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“…Mortality rate in HEU children in this study (2.2 deaths per 100 live births per year at risk) was lower than that reported from other countries in sub-Saharan Africa in the ART era, though Cox proportional hazard models. comparable with the rate previously observed in this setting (2.5 deaths per 100 live births per year at risk) [19,34]. Importantly, the mortality rate observed in HEU children may be underestimated as only children who were passively followed up at the HRPOC were included in the analysis, and therefore those who may have died before follow-up intitiation or not engaged in healthcare were not part of it.…”

Section: Discussionsupporting

confidence: 56%

“…Diarrhea (loose or watery stools more than three times in 1 day according to ICD-10 coding system) was more frequent among HEU compared with HIV-unexposed children. There is no conclusive evidence as to whether the risk of diarrhea is different in HEU compared with HIV-unexposed children in subSaharan Africa [5,19,30,35,36]. Increased risk of diarrhea-related morbidity in HEU might be a consequence of suboptimal breastfeeding rather than of HIV exposure itself.…”

Section: Discussionmentioning

confidence: 84%

“…Cohort studies from other sub-Saharan countries have shown that, before the availability of ART, HEU children had a higher mortality risk than HIV-unexposed children [4,6,29]. However, reports on mortality in HEU and HIVunexposed children in the ARTera are scarce, and results are heterogeneous [19,[30][31][32][33]. Mortality rate in HEU children in this study (2.2 deaths per 100 live births per year at risk) was lower than that reported from other countries in sub-Saharan Africa in the ART era, though Cox proportional hazard models.…”

Section: Discussionmentioning

confidence: 90%

“…The contemporaneous HIV seroprevalence among pregnant women attending the ANC clinics was 30% [15]. A prevalence of 9% of MTCT at first month of age and of 25% at the end of the first year of life has also been reported in the area [19,20]. Before 2013, PMTCT relied on antiretroviral prophylaxis, which consisted in antepartum monotherapy with zidovudine (ZDV), a singledose nevirapine (NVP) at the onset of labor, and ZDV þ lamivudine (3TC) at delivery and for 7 days post partum.…”

Section: Study Area and Populationmentioning

confidence: 94%

“…However, this study was performed only 4 years after intitiation of ART rollout in the country, and it did not evaluate health determinants among HEU children [19].…”

Section: Discussionmentioning

confidence: 99%

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Maternal HIV infection is an important health determinant in non-HIV-infected infants

Rosario

González

Maculuve

et al. 2017

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Objective: To assess morbidity and mortality in HIV-exposed uninfected (HEU) children to help guiding appropriate clinical care and effective preventive interventions.Design: This is a longitudinal study comparing two cohorts of children; one born to HIV-infected women and the other born to HIV-uninfected women. Methods:We have analyzed prospectively obtained information on nutritional status, morbidity and mortality from 966 HEU and 909 HIV-unexposed infants followed up until their first 18 months of life at a referral health facility in southern Mozambique. Determinants for adverse health outcomes in HEU children were also assessed using multivariate logistic regression.Results: Increased incidence of hospital admissions (P ¼ 0.0015), shorter survival in the first 18 months of life (P ¼ 0.0510) and moderate and severe malnutrition (P ¼ 0.0006 and 0.0014, respectively) were observed among HEU children compared with HIVunexposed children. Incidence of outpatient attendance in HEU children was associated with being men, older age and the mother being on antiretroviral treatment. Among HEU children, those who were never breastfed, or who were weaned or were partially breastfed, had an increased incidence of hospital admissions compared with children who were exclusively breastfed. Conclusion:Maternal HIV infection has important health consequences in non-HIVinfected children. As the prevalence of HIV-infected pregnant women is maintained and the proportion of HIV-infected children declines because of the scale-up of antiretroviral treatment during pregnancy and breastfeeding, more focus should be given to the health needs of HEU children to ensure that the post-2015 sustainable development goals are met.

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Section: Discussionsupporting

confidence: 56%

Section: Discussionmentioning

confidence: 84%

Section: Discussionmentioning

confidence: 90%

Section: Study Area and Populationmentioning

confidence: 94%

“…However, this study was performed only 4 years after intitiation of ART rollout in the country, and it did not evaluate health determinants among HEU children [19].…”

Section: Discussionmentioning

confidence: 99%

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Maternal HIV infection is an important health determinant in non-HIV-infected infants

Rosario

González

Maculuve

et al. 2017

Aids

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Growth and Neurodevelopment of HIV-Exposed Uninfected Children: a Conceptual Framework

et al. 2019

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Purpose of Review The population of HIV-exposed uninfected (HEU) children is expanding rapidly, and over one million HEU infants are born each year globally. Several recent studies have reported that HEU children, particularly in low-and middleincome countries, are at risk of poor outcomes, including impaired growth and neurodevelopment. However, the reasons for poor clinical outcomes amongst HEU children remain unclear. Recent Findings We summarise the findings from recent large studies that have characterised growth and neurodevelopment in HEU children, identified risk factors and explored underlying mechanistic pathways. We propose a conceptual framework to explain how exposure to HIV and antiretroviral therapy (ART) may lead to adverse growth and neurodevelopment in uninfected children, and review the available evidence and research gaps. Summary We propose that HEU children are affected both indirectly, through the augmentation of universal risk factors underlying poor growth and neurodevelopment, and directly through HIV/ART-specific pathways, which ultimately may converge through a series of common pathogenic mechanisms. In the era of universal ART, a better understanding of these pathways is crucial to inform future prevention and intervention strategies. Keywords HIV-exposed uninfected. Child. Growth. Stunting. Early child development 1000 days) represent a highly sensitive period of development, during which substantial physical growth, including brain maturation, occurs [7]. Early fetal exposures are recognised to have long-term consequences for the child Catherine J. Wedderburn and Ceri Evans contributed equally to this work.

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Child Mortality in Mozambique: a Review of Recent Trends and Attributable Causes

2018

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a) Purpose of review:In the last 25 years, child mortality has significantly dropped at a global level.Understanding particularities of child mortality at the national level is useful to tailor health policy to those conditions requiring more attention. In Mozambique, a variety of efforts have been made to better characterize the overall child mortality, and to describe the main contributors for death. In this review, we attempt to contextualize current knowledge on causes of pediatric deaths in Mozambique. b) Recent findings: The available data regarding the principal causes of death in Mozambican children point out to infectious diseases and neonatal causes as the principal causes of preventable deaths, with important variations in recent years in line with the epidemiological changes seen in the country as a result of reductions in malaria transmission and the impact of the nationwide introduction of different conjugate vaccines. c) Summary: Data regarding the main causes of death among children in Mozambique are patchy, outdated, and in many cases based on methodologies with many underlying limitations, which make them unreliable. More robust postmortem methodologies to study the underlying causes of mortality, currently being introduced in a surveillance sentinel site of the country, will surely contribute to improve our understanding of what is really killing children in this country. Keywords: Mozambique, children, mortality, cause of death, verbal autopsy, postmortem methods the year 2016 an estimated population of 28,829,476 inhabitants, 70% of which Comentado [GB(1]: I would modify this term. Comentado [GB(2]:Maybe simplify or re-order the sentence, otherwise the period referred is not very clear. Comentado [GB(3]:Aready mentioned in the sentence above: "have failed to achieve in this period the two thirds reduction in child mortality stipulated by millennium development goal (MDG) 4" Comentado [GB(4]:Some examples? (if poverty and health still faces challenges).

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Impact of HIV Exposure on Health Outcomes in HIV-Negative Infants Born to HIV-Positive Mothers in Sub-Saharan Africa

Cited by 41 publications

References 39 publications

Maternal HIV infection is an important health determinant in non-HIV-infected infants

Maternal HIV infection is an important health determinant in non-HIV-infected infants

Growth and Neurodevelopment of HIV-Exposed Uninfected Children: a Conceptual Framework

Child Mortality in Mozambique: a Review of Recent Trends and Attributable Causes

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