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.

CSDE Affiliate Dr. Alison Fohner (Epidemiology) and co-authors recently published their research in Critical Care Explorations, titled “Pharmacologic and Genetic Downregulation of Proprotein Convertase Subtilisin/Kexin Type 9 and Survival From Sepsis“. Circulating lipid and protein assemblies—lipoproteins play critical roles in clearing pathogens from the bloodstream. Authors investigated whether early inhibition of proprotein convertase subtilisin/kexin type 9 (PCSK9) may accelerate bloodstream clearance of immunogenic bacterial lipids and improve sepsis outcomes.

Their research design included genetic and clinical epidemiology, and experimental models. Nine human cohorts with sepsis (total n = 12,514) were assessed for an association between sepsis mortality and PCSK9 loss-of-function (LOF) variants. Across human cohort studies, the effect estimate for 28-day mortality after sepsis diagnosis associated with genetic PCSK9 LOF was odds ratio = 0.86 (95% CI, 0.67–1.10; p = 0.24). A significant association was present in antibiotic-treated patients. Sepsis therapies are urgently needed and further investigation into the role of PCSK9 in sepsis is needed.

CSDE Trainee Courtney Hill (Epidemiology), CSDE Affiliate Dr. Donald Chi (Health Systems and Population Health, Oral Health Sciences), and co-authors published their research in the Maternal and Child Health Journal, titled “A Mixed-Methods Study on Topical Fluoride Beliefs and Refusal Behaviors for Caregivers of Children with Special Health Care Needs”, where they aimed to understand topical fluoride-related beliefs and refusal behaviors for caregivers of children with special health care needs (CSHCN). They used an explanatory sequential mixed methods study, including a survey and interviews with children’s caregivers. While caregivers of CSHCN were not more likely to refuse topical fluoride than caregivers of healthy children, there may be important differences in the underlying reasons for refusing topical fluoride.