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Cherkos, Kinuthia, Enquobahrie, and John-Stewart Compare the Impact of Material Breastfeeding and Education with In Utero HIV/ART Exposure on Infant Growth and Development

Posted: 11/26/2023 (CSDE Research)

CSDE Affiliates Dr. Daniel Enquobahrie (Epidemiology), Dr. Grace John-Stewart (Global Health, Epidemiology, Medicine, and Pediatrics), and co-authors published their research in AIDS, titled “Maternal breastfeeding and education impact infant growth and development more than in utero HIV/ART exposure in context of universal ART: a prospective study”. This study was led by Dr. Ashenafi Cherkos as part of his PhD dissertation at UW, in addition to Dr. John Kinuthia (Global Health), who led the team in Kenya. Exposure to HIV and antiretroviral therapy (ART) in utero may influence infant growth and development. Most available evidence predates adoption of universal ART (Option B+ ART regimens). In a recent cohort, authors compared growth and development in HIV-exposed uninfected (HEU) to HIV-unexposed (HUU) infants. 

Their research design included a prospective cohort study: Data from Impact of Maternal HIV on Mycobacterium Tuberculosis Infection among Peripartum Women and their Infants (MiTIPS) in Western Kenya. Women were enrolled during pregnancy. Mother-infant pairs were followed until 24 months postpartum. Authors used multivariable linear mixed-effects models to compare growth rates (weight-for-age z-score [WAZ] and height-for-age z-score [HAZ]) and multivariable linear regression to compare overall development between HEU and HUU children. About 51.8% (184/355) of the infants were HEU, 3.9% low birthweight (<2.5 kg), and 8.5% preterm (<37 gestational weeks). During pregnancy, all mothers of HEU received ART; 67.9% started ART pre-pregnancy, and 87.3% received 3TC/FTC,TDF,EFV. In longitudinal analyses, HEU children did not differ significantly from HUU in growth or development (p > 0.05 for all). In the combined HEU/HUU cohort, higher maternal education was associated with significantly better growth and development: WAZ (β=0.18 [95% CI:0.01, 0.34]), HAZ (β=0.26 [95% CI:0.04, 0.48], and development (β=0.24 [95% CI:0.02, 0.46]). Breastfeeding was associated with significantly better HAZ (β=0.42 [95% CI:0.19, 0.66]) and development (β=0.31 [95% CI:0.08, 0.53]). HEU children in the setting of universal maternal ART had a similar growth trajectory and development to HUU children. Breastfeeding and maternal education improved children’s weight, height, and overall development irrespective of maternal HIV status.

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