Maternal and Infant Factors Associated With Failure to Thrive in Children With Vertically Transmitted Human Immunodeficiency Virus-1 Infection: The Prospective, P2C2 Human Immunodeficiency Virus Multicenter Study

Abstract

Objective-Many children with human immunodeficiency virus-1 (HIV-1) have chronic problems with growth and nutrition, yet limited information is available to identify infected children at high risk for growth abnormalities. Using data from the prospective, multicenter P 2 C 2 HIV study, we evaluated the relationships between maternal and infant clinical and laboratory factors and impaired growth in this cohort.Methods-Children of HIV-1-infected women were enrolled prenatally or within the first 28 days of life. Failure to thrive (FTT) was defined as an age-and sex-adjusted weight z score ≤−2.0 SD. Maternal baseline covariates included age, race, illicit drug use, zidovudine use, CD4 + T-cell count, and smoking. Infant baseline predictors included sex, race, CD4 + T-cell count, Centers for Disease Control stage, HIV-1 RNA, antiretroviral therapy, pneumonia, heart rate, cytomegalovirus, and Epstein-Barr virus infection status.Results-The study cohort included 92 HIV-1-infected and 439 uninfected children. Infected children had a lower mean gestational age, but birth weights, lengths, and head circumferences in the 2 groups were similar. Mothers of growth-delayed infants were more likely to have smoked Copyright © 2001 by the American Academy of Pediatrics. Reprint requests to (T.L.M.) Division of Pediatric Gastroenterology and Nutrition, Box 667, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY 14642. tracie_miller@urmc.rochester.edu. National Heart, Lung, and Blood Institute, Bethesda, MD The institutions and investigators participating in this study are listed in the "Appendix." HHS Public Access Author manuscriptPediatrics. Author manuscript; available in PMC 2015 April 03. Published in final edited form as:Pediatrics. 2001 December ; 108(6): 1287-1296. Author Manuscript Author ManuscriptAuthor ManuscriptAuthor Manuscript tobacco and used illicit drugs during pregnancy. In repeated-measures analyses of weight and length or height z scores, the means of the HIV-1-infected group were significantly lower at 6 months of age (P < .001) and remained lower throughout the first 5 years of life. Conclusion-Clinical and laboratory factors associated with FTT among HIV-1-infected children include history of pneumonia, maternal illicit drug use during pregnancy, lower infant CD4 + T-cell count, exposure to antiretroviral therapy by 3 months of age (non-protease inhibitor), and HIV-1 RNA viral load. Keywordshuman immunodeficiency virus; children; failure to thrive; growth; malnutrition Many children with human immunodeficiency virus-1 (HIV-1) infection have chronic problems with linear growth and weight gain. 1-5 A variety of disturbed growth patterns have been described, ranging from symmetric delays in weight and length or height to severe wasting with normal length or height. The differences in growth patterns probably result from differences in disease manifestations in HIV-1-infected children. In developed countries, both weight and length or height decline in infected children as early as...

Predictors of Early Mortality in a Cohort of Human Immunodeficiency Virus Type 1-Infected African Children

“…3,4,9,[28][29][30] Factors that have been shown to influence growth during this period include viral burden, increased metabolic requirements during infection and neonatal nutrition. [31][32][33][34] Growth monitoring is routine and may provide a useful indicator for further diagnostic and treatment decisions. We found that breast-feeding was protective against mortality during the first 6 months of life in this cohort of HIV-1-infected children.…”

Avaliação dos parâmetros hematológicos, virológicos e antropométricos como marcadores de progressão em crianças infectadas pelo HIV-1

“…18 Initially, an American study evidenced decrease from 1 to 0.75 in the mean of weight-for-age z score during the whole follow-up period among HIV-infected children, but there was no significant statistical difference when compared to the HIV-exposed but uninfected children. 19 Nevertheless, an elegant American prospective study 20 demonstrated later that weight and height are significantly lower among HIV-infected children when compared to those values obtained from non-infected children belonging to the same socioeconomic status at 6 months of life. Such difference was correlated with the use of illicit drugs by the mother during pregnancy and other signs of AIDS-defining disease (pneumonia episodes, CD4 T-lymphocyte count and gression like other studies.…”

“…Such difference was correlated with the use of illicit drugs by the mother during pregnancy and other signs of AIDS-defining disease (pneumonia episodes, CD4 T-lymphocyte count and gression like other studies. [20][21][22] Among the parameters derived from the CBC (total leukocyte count, TLC and hemoglobin level), only hemoglobin level at admission was useful to differentiate progressors from non-progressors in children older than 12 months. In the multivariate analysis, none of these parameters proved to be useful to predict risk of progression.…”

Longitudinal anthropometric assessment of infants born to HIV-1-infected mothers, Belo Horizonte, Southeastern Brazil

“…Many previous studies did not report differences between exposed and non-exposed infants. 7,8,11,15,17 However, one previous study reported a lower birth weight in exposed infants, 4 which was likely due to differences in the antiretroviral regimens. In the present study, the infants exposed to prophylactic treatment were heavier for their length than the children who were not exposed; this effect remained over time.…”