Extended Prophylaxis With Nevirapine Does Not Affect Growth in HIV-Exposed Infants

Carolyne Onyango-Makumbi, Arthur H. Owora, Ramadhani S. Mwiru, Anthony Mwatha, Alicia M. Young, Dhayendre Moodley, Hoosen M. Coovadia, Lynda Stranix-Chibanda, Karim Manji, Yvonne Maldonado, Paul Richardson, Philip Andrew, Kathleen George, Wafaie Fawzi, Mary Glenn Fowler

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND: Effects of prolonged nevirapine prophylaxis exposure on growth among HIV-exposed uninfected (HEU) infants are unknown. This study examines the impact of extended nevirapine prophylaxis from 6 weeks to 6 months on the growth of HEU infants followed for 18 months and also identifies correlates of incident wasting, stunting, underweight, and low head circumference in the HPTN 046 trial. METHODS: Intention-to-treat analysis examined the effect of extended nevirapine exposure on: weight-for-age Z-score, length-for-age Z-score, weight-for-length Z-score, and head circumference-for-age Z-score. Multivariable linear mixed-effects and Cox proportional hazard models were used to compare growth outcomes between the study arms and identify correlates of incident adverse growth outcomes, respectively. RESULTS: Compared to placebo, extended prophylactic nevirapine given daily from 6 weeks to 6 months did not affect growth in HEU breastfeeding (BF) infants over time (treatment × time: P > 0.05). However, overall growth declined over time (time effect: P < 0.01) when compared with WHO general population norms. Male sex was associated with higher risk of all adverse growth outcomes (P < 0.05), whereas short BF duration was associated with wasting (P = 0.03). Maternal antiretroviral therapy exposure was protective against underweight (P = 0.02). Zimbabwe tended to have worse growth outcomes especially stunting, compared to South Africa, Uganda and Tanzania (P < 0.05). CONCLUSIONS: It is reassuring that prolonged exposure to nevirapine for prevention-of-mother-to-child HIV transmission does not restrict growth. However, targeted interventions are needed to improve growth outcomes among at-risk HEU infants (i.e., male sex, short BF duration, lack of maternal antiretroviral therapy exposure, and resident in Zimbabwe).

Original languageEnglish (US)
Pages (from-to)377-385
Number of pages9
JournalJournal of acquired immune deficiency syndromes (1999)
Volume82
Issue number4
DOIs
StatePublished - Dec 1 2019

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)

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