HIV-exposed, uninfected children show growth lag

Children exposed to HIV but uninfected appear to have an initial growth deficit at birth that persists for at least the first 24 months of life, according to a meta-analysis.

Researchers searched multiple online databases for published literature on 60-month growth outcomes (length-for-age Z score [LAZ], weight-for-age Z score [WAZ], weight-for-length Z score [WLZ], head circumference-for-age Z score [HCAZ], stunting [LAZ<−2], wasting [WLZ<−2], underweight [WAZ<−2], and microcephaly [HCAZ<−2]) in children who were HIV-exposed but uninfected vs those who were HIV-unexposed.

A total of 28 studies met the eligibility criteria, of which 25 (90 percent) were conducted in Africa and 23 (82 percent) during the antiretroviral therapy (ART) period. The studies involved 11,794 children who were HIV-exposed but uninfected and 23,826 children who were HIV-unexposed.

Random-effects and fixed-effect meta-analysis were used. Results were stratified by age (birth and 0–5, 6–11, 12–17, 18–23, and 24–60 months) and ART period (pre-ART [before 2003] and ART [2003 onwards]).

Pooled data showed that LAZ was significantly lower in children who were HIV-exposed but uninfected than in those who were HIV-unexposed across all age groups in the pre-ART and ART periods.

Children who were HIV-exposed but uninfected vs HIV-unexposed also had a greater likelihood of stunting at all ages except for 0–5 months during the ART period, as well as a significantly lower WAZ from 6–11 months to 18–23 months during the pre-ART period and at all ages during the ART period.

Compared with children who were HIV-unexposed, those who were HIV-exposed were more likely to be underweight from birth through age 2 years, as well as to have significantly lower HCAZ at all ages, except for 24–60 months, during the pre-ART and ART periods. WLZ did not differ by HIV exposure.

Of note, the differences in growth outcomes between children who were HIV-exposed but uninfected and children who were HIV-unexposed tended to be more pronounced during the ART period than during the pre-ART period, particularly at younger ages.

The findings suggest that interventions to promote healthy growth in HIV-exposed children have to begin antenatally.