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

Abstract

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.

Caries experience and oral health related quality of life in a cohort of Ugandan HIV-1 exposed uninfected children compared with a matched cohort of HIV unexposed uninfected children

“…The present findings both accord with and contradict previous studies from sub-Saharan Africa reporting on increased risk of developmental delays and poor nutritional status among HEU as compared to HUU children [20][21][22]. Notably, studies indicate that before the universal availability of antiretroviral therapy, ART, HEU children had higher mortality-, morbidity and growth failure risk than HUU children, whereas later studies from the ART era show heterogeneous findings [22]. In a meta-analytic review of neurodevelopment in young children born to mothers with HIV, Mc Henry et al [40] found that children with HIV-1 and HEU had worse health outcomes than their HUU counterparts and moreover, that HEU children without exposure to ART had worse health outcomes than their ART exposed counterparts.…”

“…On the other side there were indications of a minor developmental delay in eruption of permanent teeth among HEU children presenting with significantly higher number of non-exfoliated primary teeth than HUU children [45]. The present findings both accord with and contradict previous studies from sub-Saharan Africa reporting on increased risk of developmental delays and poor nutritional status among HEU as compared to HUU children [20][21][22]. Notably, studies indicate that before the universal availability of antiretroviral therapy, ART, HEU children had higher mortality-, morbidity and growth failure risk than HUU children, whereas later studies from the ART era show heterogeneous findings [22].…”

“…Studies from various settings have reported that HIV exposed, uninfected children (HEU) have poorer health outcomes than HIV unexposed uninfected children (HUU) [19][20][21][22][23]. Thus, HEU children seem to be disadvantaged with respect to birth outcomes such as preterm birth, linear growth, metabolism, adaptive and innate immune systems; and increased infectious morbidity [24].…”

Association of maternal HIV‐1 severity with dental caries: an observational study of uninfected 5‐ to 7‐yr‐old children of HIV‐1‐infected mothers without severe immune suppression

“…Although the effects of exposure to HIV‐1 during pregnancy, delivery, and lactation on the postnatal development of HEU children remain uncertain, previous studies in sub‐Saharan Africa have reported increased infant morbidity according to low maternal CD4 counts, which is not explained by maternal mortality . By contrast, low maternal CD4 count did not increase the IRRs of having caries in primary teeth for the HEU children investigated in this study.…”

Caries experience and oral health related quality of life in a cohort of Ugandan HIV-1 exposed uninfected children compared with a matched cohort of HIV unexposed uninfected children

“…On the other side there were indications of a minor developmental delay in eruption of permanent teeth among HEU children presenting with significantly higher number of nonexfoliated primary teeth than HUU children [45]. The present findings both accord with and contradict previous studies from sub-Saharan Africa reporting on increased risk of developmental delays and poor nutritional status among HEU as compared to HUU children [20][21][22]. Notably, studies indicate that before the universal availability of antiretroviral therapy, ART, HEU children had higher mortality-, morbidity and growth failure risk than HUU children, whereas later studies from the ART era show heterogeneous findings [22].…”