7th IAS Conference on HIV Pathogenesis, Treatment and Prevention (IAS 2013)

Abstract

MOPE042 - Poster Exhibition


In utero HAART exposure associated with decreased growth among HIV-exposed uninfected breastfed infants in Botswana

K.M. Powis1,2,3, L. Smeaton4, W. Fawzi5, A. Ogwu3, E. Machakaire3, S. Souda3, K. Wirth3,6, J. Makhema3, S. Lockman2,3,7, M. Essex2,3, R.L. Shapiro2,3,8

1Massachusetts General Hospital, Division of Global Health, Boston, United States, 2Harvard School of Public Health, Department of Immunology and Infectious Diseases, Boston, United States, 3Botswana-Harvard School of Public Health AIDS Partnership Institute, Gaborone, Botswana, 4Harvard School of Public Health, Center for Biostatistics in AIDS Research, Boston, United States, 5Harvard School of Public Health, Department of Global Health and Population, Boston, United States, 6Harvard School of Public Health, Department of Epidemiology, Boston, United States, 7Brigham and Women's Hospital, Infectious Disease Unit, Boston, United States, 8Beth Israel Deaconess Medical Center, Division of Infectious Diseases, Boston, United States

Background: Lower birth weights have been reported among HIV-uninfected infants exposed in utero to highly active antiretroviral therapy (HAART) as compared with ZDV alone. The longer term growth impact of in utero antiretroviral exposure has not been well studied in HIV-exposed uninfected children.
Methods: The Mashi and Mma Bana studies enrolled HIV-infected pregnant women from the same 4 sites in Botswana. Infant weight and length were routinely measured through 24 months-of-life. This analysis includes singleton infants born ≥37 weeks' gestation to mothers receiving either HAART or ZDV >2 weeks before delivery, breast fed from birth (for up to 6 months, per protocols), HIV-negative through 18-24 months and for whom weight/length measurements were obtained at 24 months-of-life. Infants remained AZT (direct ingestion) or HAART-exposed (through breastfeeding) while breastfeeding. Weight-for-age (WAZ), length-for-age (LAZ), and weight-for-length (WLZ) z-scores were derived from WHO Child Growth Standards. WAZ, LAZ and WLZ were compared by antiretroviral exposure group at 24 months (t-test and linear regression).
Results: 821 infants (305 AZT-exposed from Mashi, 516 HAART-exposed from Mashi [23 infants] or Mma Bana [493 infants]) were included in this analysis. Median enrollment CD4 counts were 392 in AZT-treated and 324 in HAART-treated mothers (p< 0.001); median duration of in utero exposure to AZT and HAART was 5.7 weeks (range 2.0-10.9 weeks) and 12.0 weeks (range 2.4-22.9), respectively (p< 0.001); and median months breastfed was 5.9 and 6.0, respectively (p=0.39). At 24 months, WAZ and LAZ were significantly lower in HAART exposed infants (mean WAZ -0.51 vs -0.28; p=0.002) (LAZ -1.00 vs -0.71; p=0.001) in unadjusted analyses, while WLZ did not vary significantly (WLZ -0.02 vs +0.09; p =0.19). After adjusting for maternal CD4, viral load, enrollment site, in utero ARV exposure duration and maternal BMI one month postpartum, in utero HAART exposure remained significantly associated with lower mean WAZ (p< 0.001) and LAZ (p< 0.001).
Conclusions: At 2 years of life, mean weight and length z-scores of infants with in utero HAART exposure were significantly lower than AZT-exposed infants in unadjusted and adjusted analyses. These findings may have long-term impact on morbidity and mortality for HAART-exposed infants.

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