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SIMILAR EARLY GROWTH IN HEU AND HUU
INFANTS WITH MATERNAL ART OPTIMIZATION
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Abstract Body
While early growth differences between HIV exposed uninfected (HEU) and HIV unexposed uninfected infants (HUU) have been demonstrated, it is not known if these persist in the era of optimized maternal antiretroviral therapy (ART), including dolutegravir (DTG). We compared growth between HEU and HUU infants and evaluated the influence of maternal ART regimen, timing of ART initiation, and maternal viral load (VL) on growth in HEU infants.
HEU and HUU mother-infant pairs between the ages of 4 and 8 weeks were enrolled in 6 clinics in Nairobi and Kisumu, Kenya from March-September 2021. Continuous growth measures were calculated using WHO Z-scores (weight-for-age [WAZ], length-for-age [LAZ], weight-for-length [WLZ], head circumference-for-age [HCAZ)]. Growth faltering was defined as underweight (WAZ<-2), stunting (HAZ<-2), wasting (HAZ<-2), and microcephaly (HCZ<-2). Linear regression models were used to compare continuous growth outcomes and Poisson regression to determine prevalence ratios (PR) and 95% confidence intervals (CI) for growth faltering outcomes.
Of 1148 infants, 365 were HEU and 783 were HUU. Median age was 6 weeks (IQR: 6-7 weeks). HEU infants were more likely to be exclusively breastfed than HUU (Table 1). Women living with HIV (WLHIV) were older, had lower education, reported more moderate to severe household hunger and were underweight (BMI<18.5) compared to HIV-uninfected mothers. All WLHIV were on ART in pregnancy with 62% on DTG-based and 29% on Efavirenz-based regimens.
Median duration on ART was 53 months (IQR: 16, 86 months). Most (85%) started ART pre-conception and 95% were virally suppressed in pregnancy. 97% of HEU were on ARV prophylaxis; 52% on NVP and 47% on AZT+NVP. HEU infants had similar LAZ, WAZ, WLZ, HCZ compared to HUU in unadjusted or adjusted models; there were no differences in prevalence of underweight, wasting, stunting, or microcephaly (p>0.05). Among HEU infants, there were no significant growth differences by timing of maternal ART initiation, regimen type, maternal VL or infant ARV prophylaxis.
HEU infants had similar growth in early infancy compared to HUU peers. Optimized maternal ART regimens and early ART initiation may result in similar early growth among HEU infants.
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