Background
Children who were HIV exposed and uninfected (CHEU) may experience higher levels of oxidative stress and inflammation compared to children who are HIV unexposed (CHU). Telomere length (TL) is an important biomarker of aging. Telomere shortening results from cellular division, inflammation, and oxidative stress and is associated with age-related diseases. We compared TL between CHEU and CHU.
Methods
CHEU and CHU attending 7 public maternal and child health clinics were enrolled at their 6-week visit in the HOPE cohort from 2021-2022 in Kenya. Mothers of CHEU were on optimized antiretroviral therapy (ART). TL was measured from dried blood spots at 6 weeks of age using a modified version of the monochrome multiplex qPCR assay. We used linear mixed effects models with clinic as a random effect. Adjustment variables included infant age at DBS collection, infant sex, maternal age, paternal age, and maternal education. The statistical analysis plan was pre-registered prior to availability of TL data.
Results
Between 250 CHEU and 250 CHU, there were no significant differences (p=0.05) in child sex (51% female), median age at sample collection (median: 6.6 weeks), or preterm birth (2.8%). CHEU had older mothers (median: 31 vs 26 years), older fathers (median: 37 vs 31 years), and mothers with fewer years of education (median: 8 vs 12 years) compared to CHU. The majority (88%) of mothers of CHEU started ART before pregnancy and 47% of those mothers were on dolutegravir-based regimens before pregnancy.
Mean TL z-score was -0.04 (standard deviation [SD]: 0.99) among CHEU and 0.04 (SD: 1.01) among CHU. HIV exposure was not significantly associated with TL in the unadjusted (-0.08, 95% confidence intervals [CI]: -0.26, 0.09, p=0.375) or adjusted models (-0.05, 95%CI: -0.26, 0.15, p=0.604).
Conclusions
In this relatively large cohort of CHEU and CHU, there was no significant difference in 6-week TL between CHEU and CHU. Future analyses will include longitudinal comparisons of the rate of TL decline between CHEU and CHU and analyses among CHEU to determine whether maternal ART regimen or viral load influence child TL.
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