Maternal breastfeeding and education impact infant growth and development more than in-utero HIV/antiretroviral therapy exposure in context of universal antiretroviral therapy

• Published in: AIDS (London) Vol. 38; no. 4; pp. 537 - 546
• Main Authors: Cherkos, Ashenafi S, LaCourse, Sylvia M, Kinuthia, John, Mecha, Jerphason, Enquobahrie, Daniel A, Escudero, Jaclyn N, John-Stewart, Grace
• Format: Journal Article
• Language: English
• Published: England 15.03.2024
• ISSN: 0269-9370; 1473-5571; 1473-5571
• DOI: 10.1097/QAD.0000000000003785

Exposure to HIV and antiretroviral therapy (ART) in utero may influence infant growth and development. Most available evidence predates adoption of universal ART (Option B+ ART regimens). In a recent cohort, we compared growth and development in HIV-exposed uninfected (HEU) to HIV-unexposed (HUU) infants. Prospective cohort study: data from Impact of Maternal HIV on Mycobacterium Tuberculosis Infection among Peripartum Women and their Infants (MiTIPS) in Western Kenya. Women were enrolled during pregnancy. Mother-infant pairs were followed 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 between HEU and HUU children. About 51.8% (184/355) of the infants were HEU, 3.9% low birthweight (<2.5 kg), and 8.5% preterm (<37 gestational weeks). During pregnancy, all mothers of HEU received ART; 67.9% started ART prepregnancy, and 87.3% received 3TC/FTC, TDF, and EFV. In longitudinal analyses, HEU children did not differ significantly from HUU in growth or development ( P  > 0.05 for all). In the combined HEU/HUU cohort, 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)]. HEU children in the setting of universal maternal ART had a similar growth trajectory and development to HUU children. Breastfeeding and maternal education improved children's weight, height, and overall development irrespective of maternal HIV status.