Abstract Body

Background:

Exposure to HIV and antiretroviral therapy (ART) in utero may influence infant growth and development. Most available evidence predates the adoption of Option B+ (women with HIV are immediately offered ART, regardless of their CD4 count, in order to prevent vertical transmission). We compared growth and development in HIV-exposed uninfected (HEU) to HIV-unexposed (HUU) infants in a recent cohort.

Methods:

This analysis used data from a prospective birth cohort of women with and without HIV infection, and their infants in Western Kenya. Women were enrolled during pregnancy and followed up until 24 months postpartum. We used multivariable linear mixed-effects models to compare growth rates (weight-for-age z-score [WAZ] and height-for-age z-score [HAZ]) and multivariable linear regression to compare overall development (assessed with caregiver-reported early development instruments [CREDI]) between HEU and HUU children.

Results:

Among 355 infants, 184 (51.8%) were HEU infants, 3.9% (14/355) were low birthweight, and 8.5% (26/307) were preterm. Median maternal age (interquartile range [IQR]) was 25.0 (22.0-29.0) years; mothers of HEU children were older and had higher incomes. During pregnancy all mothers of HEU children received ART; 67.9% (125/184) started ART pre-pregnancy and 87.3% (158/181) received 3TC/FTC,TDF,EFV. longitudinal linear analyses, HEU children did not differ significantly from HUU in growth or development (p >0.05 for all). In the combined HEU/HUU children cohort, adjusted for potential confounders, higher maternal education was associated with significantly better growth and development: WAZ (β=0.18 [95% CI:0.01, 0.34]), HAZ (β=0.26 [95% CI: 0.04, 0.48], and development (β=0.24 [95% CI: 0.02, 0.46]). Breastfeeding was associated with significantly better HAZ (β=0.42 [95% CI: 0.19, 0.66]) and development (β=0.31 [95% CI: 0.08, 0.53]).

Conclusions:

HEU children had a similar growth trajectory and development to HUU children. Breastfeeding and maternal education improved weight, height, and overall development of children irrespective of maternal HIV status.