Growth patterns among HIV-exposed infants receiving nevirapine prophylaxis in Pune, India

Malathi Ram, Nikhil Gupte, Uma Nayak, Aarti A. Kinikar, Mangesh Khandave, Anita V Shankar, Jayagowri Sastry, Robert C Bollinger, Amita Gupta

Research output: Contribution to journalArticle

Abstract

Background: India has among the highest rates of infant malnutrition. Few studies investigating the growth patterns of HIV-exposed infants in India or the impact of timing of HIV infection on growth in settings such as India exist. Methods: We used data from the Six Week Extended Nevirapine (SWEN) trial to compare the growth patterns of HIV-infected and HIV-exposed but uninfected infants accounting for timing of HIV infection, and to identify risk factors for stunting, underweight and wasting. Growth and timing of HIV infection were assessed at weeks 1, 2, 4, 6, 10, 14 weeks and 6, 9, 12 months of life. Random effects multivariable logistic regression method was used to assess factors associated with stunting, underweight and wasting.Results: Among 737 HIV-exposed infants, 93 (13%) were HIV-infected by 12 months of age. Among HIV-infected and uninfected infants, baseline prevalence of stunting (48% vs. 46%), underweight (27% vs. 26%) and wasting (7% vs. 11%) was similar (p>0.29), but by 12 months stunting and underweight, but not wasting, were significantly higher in HIV-infected infants (80% vs. 56%, 52% vs. 29%, p<0.0001; 5% vs. 6%, p=0.65, respectively). These differences rapidly manifested within 4-6 weeks of birth. Infants infected in utero had the worst growth outcomes during the follow-up period. SWEN was associated with non-significant reductions in stunting and underweight among HIV-infected infants and significantly less wasting in HIV-uninfected infants. In multivariate analysis, maternal CD4 <250, infant HIV status, less breastfeeding, low birth weight, non-vaginal delivery, and infant gestational age were significant risk factors for underweight and stunting.Conclusion: Baseline stunting and underweight was high in both HIV-infected and uninfected infants; growth indices diverged early and were impacted by timing of infection and SWEN prophylaxis. Early growth monitoring of all HIV-exposed infants is an important low-cost strategy for improving health and survival outcomes of these infants.Trial Registration: NCT00061321.

Original languageEnglish (US)
Article number282
JournalBMC Infectious Diseases
Volume12
DOIs
StatePublished - Oct 31 2012

Fingerprint

Nevirapine
India
Growth Disorders
HIV
Thinness
Growth
HIV Infections
Infant Nutrition Disorders
Low Birth Weight Infant
Breast Feeding
Gestational Age

Keywords

  • Extended use of nevirapine
  • Growth patterns
  • HIV-exposed infants
  • India
  • Risk factors
  • Timing of HIV Infection

ASJC Scopus subject areas

  • Infectious Diseases

Cite this

Growth patterns among HIV-exposed infants receiving nevirapine prophylaxis in Pune, India. / Ram, Malathi; Gupte, Nikhil; Nayak, Uma; Kinikar, Aarti A.; Khandave, Mangesh; Shankar, Anita V; Sastry, Jayagowri; Bollinger, Robert C; Gupta, Amita.

In: BMC Infectious Diseases, Vol. 12, 282, 31.10.2012.

Research output: Contribution to journalArticle

@article{34b87b0fc44646b48abb52a4de6d9041,
title = "Growth patterns among HIV-exposed infants receiving nevirapine prophylaxis in Pune, India",
abstract = "Background: India has among the highest rates of infant malnutrition. Few studies investigating the growth patterns of HIV-exposed infants in India or the impact of timing of HIV infection on growth in settings such as India exist. Methods: We used data from the Six Week Extended Nevirapine (SWEN) trial to compare the growth patterns of HIV-infected and HIV-exposed but uninfected infants accounting for timing of HIV infection, and to identify risk factors for stunting, underweight and wasting. Growth and timing of HIV infection were assessed at weeks 1, 2, 4, 6, 10, 14 weeks and 6, 9, 12 months of life. Random effects multivariable logistic regression method was used to assess factors associated with stunting, underweight and wasting.Results: Among 737 HIV-exposed infants, 93 (13{\%}) were HIV-infected by 12 months of age. Among HIV-infected and uninfected infants, baseline prevalence of stunting (48{\%} vs. 46{\%}), underweight (27{\%} vs. 26{\%}) and wasting (7{\%} vs. 11{\%}) was similar (p>0.29), but by 12 months stunting and underweight, but not wasting, were significantly higher in HIV-infected infants (80{\%} vs. 56{\%}, 52{\%} vs. 29{\%}, p<0.0001; 5{\%} vs. 6{\%}, p=0.65, respectively). These differences rapidly manifested within 4-6 weeks of birth. Infants infected in utero had the worst growth outcomes during the follow-up period. SWEN was associated with non-significant reductions in stunting and underweight among HIV-infected infants and significantly less wasting in HIV-uninfected infants. In multivariate analysis, maternal CD4 <250, infant HIV status, less breastfeeding, low birth weight, non-vaginal delivery, and infant gestational age were significant risk factors for underweight and stunting.Conclusion: Baseline stunting and underweight was high in both HIV-infected and uninfected infants; growth indices diverged early and were impacted by timing of infection and SWEN prophylaxis. Early growth monitoring of all HIV-exposed infants is an important low-cost strategy for improving health and survival outcomes of these infants.Trial Registration: NCT00061321.",
keywords = "Extended use of nevirapine, Growth patterns, HIV-exposed infants, India, Risk factors, Timing of HIV Infection",
author = "Malathi Ram and Nikhil Gupte and Uma Nayak and Kinikar, {Aarti A.} and Mangesh Khandave and Shankar, {Anita V} and Jayagowri Sastry and Bollinger, {Robert C} and Amita Gupta",
year = "2012",
month = "10",
day = "31",
doi = "10.1186/1471-2334-12-282",
language = "English (US)",
volume = "12",
journal = "BMC Infectious Diseases",
issn = "1471-2334",
publisher = "BioMed Central",

}

TY - JOUR

T1 - Growth patterns among HIV-exposed infants receiving nevirapine prophylaxis in Pune, India

AU - Ram, Malathi

AU - Gupte, Nikhil

AU - Nayak, Uma

AU - Kinikar, Aarti A.

AU - Khandave, Mangesh

AU - Shankar, Anita V

AU - Sastry, Jayagowri

AU - Bollinger, Robert C

AU - Gupta, Amita

PY - 2012/10/31

Y1 - 2012/10/31

N2 - Background: India has among the highest rates of infant malnutrition. Few studies investigating the growth patterns of HIV-exposed infants in India or the impact of timing of HIV infection on growth in settings such as India exist. Methods: We used data from the Six Week Extended Nevirapine (SWEN) trial to compare the growth patterns of HIV-infected and HIV-exposed but uninfected infants accounting for timing of HIV infection, and to identify risk factors for stunting, underweight and wasting. Growth and timing of HIV infection were assessed at weeks 1, 2, 4, 6, 10, 14 weeks and 6, 9, 12 months of life. Random effects multivariable logistic regression method was used to assess factors associated with stunting, underweight and wasting.Results: Among 737 HIV-exposed infants, 93 (13%) were HIV-infected by 12 months of age. Among HIV-infected and uninfected infants, baseline prevalence of stunting (48% vs. 46%), underweight (27% vs. 26%) and wasting (7% vs. 11%) was similar (p>0.29), but by 12 months stunting and underweight, but not wasting, were significantly higher in HIV-infected infants (80% vs. 56%, 52% vs. 29%, p<0.0001; 5% vs. 6%, p=0.65, respectively). These differences rapidly manifested within 4-6 weeks of birth. Infants infected in utero had the worst growth outcomes during the follow-up period. SWEN was associated with non-significant reductions in stunting and underweight among HIV-infected infants and significantly less wasting in HIV-uninfected infants. In multivariate analysis, maternal CD4 <250, infant HIV status, less breastfeeding, low birth weight, non-vaginal delivery, and infant gestational age were significant risk factors for underweight and stunting.Conclusion: Baseline stunting and underweight was high in both HIV-infected and uninfected infants; growth indices diverged early and were impacted by timing of infection and SWEN prophylaxis. Early growth monitoring of all HIV-exposed infants is an important low-cost strategy for improving health and survival outcomes of these infants.Trial Registration: NCT00061321.

AB - Background: India has among the highest rates of infant malnutrition. Few studies investigating the growth patterns of HIV-exposed infants in India or the impact of timing of HIV infection on growth in settings such as India exist. Methods: We used data from the Six Week Extended Nevirapine (SWEN) trial to compare the growth patterns of HIV-infected and HIV-exposed but uninfected infants accounting for timing of HIV infection, and to identify risk factors for stunting, underweight and wasting. Growth and timing of HIV infection were assessed at weeks 1, 2, 4, 6, 10, 14 weeks and 6, 9, 12 months of life. Random effects multivariable logistic regression method was used to assess factors associated with stunting, underweight and wasting.Results: Among 737 HIV-exposed infants, 93 (13%) were HIV-infected by 12 months of age. Among HIV-infected and uninfected infants, baseline prevalence of stunting (48% vs. 46%), underweight (27% vs. 26%) and wasting (7% vs. 11%) was similar (p>0.29), but by 12 months stunting and underweight, but not wasting, were significantly higher in HIV-infected infants (80% vs. 56%, 52% vs. 29%, p<0.0001; 5% vs. 6%, p=0.65, respectively). These differences rapidly manifested within 4-6 weeks of birth. Infants infected in utero had the worst growth outcomes during the follow-up period. SWEN was associated with non-significant reductions in stunting and underweight among HIV-infected infants and significantly less wasting in HIV-uninfected infants. In multivariate analysis, maternal CD4 <250, infant HIV status, less breastfeeding, low birth weight, non-vaginal delivery, and infant gestational age were significant risk factors for underweight and stunting.Conclusion: Baseline stunting and underweight was high in both HIV-infected and uninfected infants; growth indices diverged early and were impacted by timing of infection and SWEN prophylaxis. Early growth monitoring of all HIV-exposed infants is an important low-cost strategy for improving health and survival outcomes of these infants.Trial Registration: NCT00061321.

KW - Extended use of nevirapine

KW - Growth patterns

KW - HIV-exposed infants

KW - India

KW - Risk factors

KW - Timing of HIV Infection

UR - http://www.scopus.com/inward/record.url?scp=84868225521&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84868225521&partnerID=8YFLogxK

U2 - 10.1186/1471-2334-12-282

DO - 10.1186/1471-2334-12-282

M3 - Article

C2 - 23114104

AN - SCOPUS:84868225521

VL - 12

JO - BMC Infectious Diseases

JF - BMC Infectious Diseases

SN - 1471-2334

M1 - 282

ER -