Linear Growth Faltering Among HIV-Exposed Uninfected Children.
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Author list: Sudfeld CR, Lei Q, Chinyanga Y, Tumbare E, Khan N, Dapaah-Siakwan F, Sebaka A, Sibiya J, van Widenfelt E, Shapiro RL, Makhema J, Fawzi WW, Powis KM
Publisher: Lippincott, Williams & Wilkins
Publication year: 2016
Journal: Journal of Acquired Immune Deficiency Syndromes (1525-4135)
Journal acronym: J Acquir Immune Defic Syndr
Volume number: 73
Issue number: 2
Start page: 182
End page: 9
Number of pages: -172
ISSN: 1525-4135
eISSN: 1944-7884
Languages: English-Great Britain (EN-GB)
Abstract
BACKGROUND\nMETHODS\nRESULTS\nCONCLUSION\nHIV-exposed uninfected (HEU) children experience increased mortality compared with their HIV-unexposed uninfected (HUU) peers. It is unclear whether HEU children are also at increased risk for undernutrition, a modifiable risk factor for mortality.\nWe conducted a cross-sectional, population-based survey of children <5 years of age in 5 health districts in Botswana. Linear mixed-effects models were used to assess continuous outcomes, and generalized estimating equations were used to estimate relative risks of stunting, wasting, and underweight between HEU (n = 396) and HUU (n = 1109) children. Secondary analyses examined potential mediation by low birth weight.\nThe association between maternal HIV exposure and child stunting varied significantly by child age (P < 0.01). HEU children <1 and ≥2 years of age had 1.85 [95% confidence interval (CI): 1.03 to 3.31; P = 0.04] and 1.41 (95% CI: 1.06 to 1.88; P = 0.02) times the risk of stunting compared with HUU children after multivariate adjustment, respectively. During the period of 1-2 years of age, when breastfeeding cessation occurred among HUU children, HUU children had increased risk of stunting compared with HEU children who were predominantly formula fed (relative risk: 1.56; 95% CI: 1.05 to 2.32; P = 0.03). A mediation analysis estimated that 67% of the excess risk of stunting among HEU children ≥2 years was attributable to low birth weight (P = 0.02). There was no difference in risk of wasting or underweight.\nHEU children are at increased risk of stunting compared with their HUU peers; however, interventions to increase birth weight may significantly ameliorate this excess risk. Interventions to support optimal growth during weaning are needed for all breast-fed children.
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