122 - Attained stature of HIV exposed Ugandan children by 6-18 years of life according to In-utero or peripartum antiretroviral therapy exposure type

Poster Number: 122
Publication Number: 122.2072

Background: Children perinatally HIV infected (CPHIV) or HIV exposed but uninfected (CHEU), are exposed to antiretroviral drugs in early life with unknown impact on attained stature in the long-term.

Objective: To examine the effect of early antiretroviral treatment on growth of Adolescents

Design/Methods: 759 children (254 CPHIV, 254 CHEU and 251 HIV-unexposed uninfected (CHUU) born between the years 2000 and 2011 were enrolled at 6 to 18 years old and followed for 12 months with height-for-age (HAZ) determined at intake, 6 and 12 months relative to WHO reference. HIV exposed children’s in-utero/peripartum antiretroviral (IPA) exposure was established by objective medical records and categorized as: no IPA, single-dose nevirapine with/without zidovudine (sdNVP±AZT), sdNVP+AZT+Lamivudine (3TC), or combination ART (cART). Multivariable linear regression models adjusted for time and caregiver factors (sex, age, education, functioning in caregiving role and lifetime adversity) estimated standardized mean difference (SMD) with 95% confidence intervals (95%CI) in HAZ over 12 months according to IPA exposure for CPHIV and CHEU relative to CHUU in Statistical Analysis Software (v.9.4).

Results: Most HIV-exposed children (n=250, 49.2%) had no IPA, while 108 (21.5%), 75 (14.8%) and 75 (14.8%) were respectively exposed to sdNVP±AZT, sdNVP+AZT+3TC and cART. Regardless of IPA type, CPHIV were at growth disadvantage relative to CHUU by school-age/adolescence (SMD=-0.36, 95%CI: -0.54, -0.18). For CHEU compared to CHUU, attained stature by school-age/adolescence varied by IPA exposure type. Specifically, CHEU exposed to sdNVP±AZT (SMD= -0.21, 95%CI: -0.54, 0.09) and CHEU exposed to sdNVP+AZT+3TC (SMD=0.06, 95%CI: -0.21, 0.32) had comparable stature whereas no IPA exposure (SMD= -0.27, 95% CI: -0.52, -0.01) predicted a growth disadvantage relative to CHUU. However, CHEU with cART-based IPA exposure (SMD=0.40, 95%CI: 0.08, 0.71) achieved greater stature than CHUU by 6-18 years.

Conclusion(s): The finding that CHEU with IPA regimen exposure grew as well as or better (if cART-based IPA) than CHUU by 6 – 18 years old is encouraging evidence affirming that CHEU thrive with respect to attained stature by school-age and adolescent years despite IPA exposure. Growth deficits persist for CPHIV regardless of IPA exposure type and for CHEU with no IPA exposure highlighting the need for continued vigilance and stressing need for specific interventions to support their long-term growth.