@article{0840e22dc6194175bb1e2bb71156f22e,
title = "In-utero triple antiretroviral exposure associated with decreased growth among HIV-exposed uninfected infants in Botswana",
abstract = "Objective: To assess associations between in-utero triple antiretrovirals (cART) versus zidovudine (ZDV) monotherapy exposure and growth among HIV-uninfected children of HIV-infected women in Botswana. Design: Secondary retrospective data analysis from two randomized intervention trials of mother-to-child HIV transmission prevention. Methods: The Mashi and Mma Bana studies enrolled HIV-infected pregnant women, following their children through 24 months of age. This analysis includes singleton, fullterm, HIV-exposed uninfected children. Mothers received cART or ZDV at least 2 weeks predelivery, and breastfed up to 6 months. Weight-for-age (WAZ), length-for-age (LAZ) and weight-for-length (WLZ) z-scores were derived. Mean z-scores were compared by exposure group at 24 months (t-test, linear regression). Results: Of 819 children, 303 were ZDV-and 516 cART-exposed in utero. Maternal median enrolment CD4 was higher among ZDV versus cART-treated mothers (393 versus 324 cells/ml; P<0.0001). Median duration of antepartum antiretroviral use was shorter among ZDV-treated women (5.7 versus 12.0 weeks; P<0.0001). Median months breastfed were similar (5.9 and 6.0; P=0.43). At 24 months, mean LAZ and WAZwere significantly lower among cART-exposed children (LAZ-1.01 versus-0.74; P=0.003) (WAZ-0.53 versus-0.30; P=0.002) in unadjusted analyses. Adjusting for maternal CD4, viral load, enrolment site and maternal anthropometric measures, cART-exposed children had significantly lower LAZ and WAZ at 24 months (P=0.0004 for both). Conclusion: At 24 months, in-utero cART-exposed children had significantly lower LAZ and WAZ. Poor growth impacts childhood and adult mortality. These findings raise concerns for potential lasting health impacts among HIV-exposed uninfected children with in-utero cART exposure.",
keywords = "Growth, HIV-exposed uninfected infants, in-utero triple antiretrovirals",
author = "Powis, {Kathleen M.} and Laura Smeaton and Hughes, {Michael D.} and Tumbare, {Esther A.} and Sajini Souda and Jennifer Jao and Wirth, {Kathleen E.} and Joseph Makhema and Shahin Lockman and Wafaie Fawzi and Max Essex and Shapiro, {Roger L.}",
note = "Funding Information: K.M.P. was a study physician on the Mma Bana study, performed the analyses in this manuscript and was the primary author of the manuscript. L.S., M.D.H. and K.W. assisted K.M.P. with statistical analyses. M.D.H. was the senior statistician and co-investigator on the Mma Bana study. E.A.T. and S.S. were Mma Bana Study physicians, and J.M. provided oversight to the conduct of the Mma Bana study. M.E. was the principal investigator of the Mashi study. S.L. and R.L.S. were study physicians and co-investigators on the Mashi study and R.L.S. was the principal investigator of the Mma Bana Study. J.J. and W.F., with expertise in child growth studies, assisted with manuscript drafting and all authors reviewed and approved the final version of this manuscript. M.H. has served as a paid Data Safety and Monitoring Board member for Boehringer Ingelheim, Pfizer, Tibotec and Medicines Development. L.S. served as a paid Data Monitoring Committee member for Pfizer. K.M.P. received salary support from the National Institute of Child Health and Human Development (1K23HD070774-01A1). J.J. received salary support from the National Institute of Child Health and Human Development (1K23HD070760-01A1). The Mashi study was supported by a grant from the National Institutes of Health, National Institute of Child Health and Human Development (R01 HD37793). The Mma Bana study was supported by a grant from the National Institute of Allergy and Infectious Diseases (U01-AI066454). Funding support from Brigham andWomen''s GlobalWomen''s Health Fellowship supported K.P.''s salary during the Mma Bana study. The Fogarty AITRP grant (D43 TW000004) provided funding for A.O. and S.M. Mma Bana study drugs were provided by Abbott Pharmaceuticals, GlaxoSmithKline, and the government of Botswana. NCT00197587 (Mashi) and NCT00270296 (Mma Bana). Publisher Copyright: {\textcopyright} 2016 Wolters Kluwer Health, Inc. All rights reserved.",
year = "2016",
doi = "10.1097/QAD.0000000000000895",
language = "English (US)",
volume = "30",
pages = "211--220",
journal = "AIDS",
issn = "0269-9370",
publisher = "Lippincott Williams and Wilkins",
number = "2",
}
