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2020-07-02
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INFECTIOUS MORBIDITY, MORTALITY AND NUTRITION IN HIV-EXPOSED, UNINFECTED, FORMULA FED INFANTS: RESULTS FROM THE HPTN 040/PACTG 1043 TRIAL
https://www.arca.fiocruz.br/handle/icict/29114
Author
Affilliation
University of California, Los Angeles. David Geffen School of Medicine. Los Angeles, CA, USA.
US Department of State. Office of the Global AIDS Coordinator and Health Diplomacy. Washington, DC, USA.
Westat. Rockville, MD, USA.
University of California, Los Angeles. David Geffen School of Medicine. Los Angeles, CA, USA.
Hospital Federal dos Servidores do Estado. Rio de Janeiro, RJ, Brasil.
Hospital Geral de Nova Iguaçu. Nova Iguaçu, RJ Brasil / Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de AIDS e Imunologia Molecular. Rio de Janeiro, RJ, Brasil.
Stellenbosch University. Perinatal HIV Research Unit. Cape Town, South Africa / Tygerberg Hospital. Cape Town, South Africa.
University of Witwatersrand. Johannesburg, South Africa / Chris Hani Baragwanath Hospital, Johannesburg, South Africa.
Hospital Conceição. Porto Alegre, RS, Brasil.
Hospital Femina. Porto Alegre, RS, Brasil.
Irmandade da Santa Casa de Misericórdia de Porto Alegre. Porto Alegre, RS, Brasil.
Federal University of Minas Gerais. Belo Horizonte, MG, Brazil.
Universidade de São Paulo. Ribeirão Preto, SP, Brasil.
Fundação Oswaldo Cruz. Instituto de Pesquisa Clínica Evandro Chagas. Laboratório de Pesquisa Clínica em DST e AIDS. Rio de Janeiro, RJ, Brasil.
Westat. Rockville, MD, USA.
Elisabeth Glaser Pediatric AIDS Foundation. Washington, DC, USA.
National Institutes of Health. Eunice Kennedy Shriver National Institute of Child Health and Human Development. Bethesda, MD, USA.
University of California, Los Angeles. David Geffen School of Medicine. Los Angeles, CA, USA.
US Department of State. Office of the Global AIDS Coordinator and Health Diplomacy. Washington, DC, USA.
Westat. Rockville, MD, USA.
University of California, Los Angeles. David Geffen School of Medicine. Los Angeles, CA, USA.
Hospital Federal dos Servidores do Estado. Rio de Janeiro, RJ, Brasil.
Hospital Geral de Nova Iguaçu. Nova Iguaçu, RJ Brasil / Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de AIDS e Imunologia Molecular. Rio de Janeiro, RJ, Brasil.
Stellenbosch University. Perinatal HIV Research Unit. Cape Town, South Africa / Tygerberg Hospital. Cape Town, South Africa.
University of Witwatersrand. Johannesburg, South Africa / Chris Hani Baragwanath Hospital, Johannesburg, South Africa.
Hospital Conceição. Porto Alegre, RS, Brasil.
Hospital Femina. Porto Alegre, RS, Brasil.
Irmandade da Santa Casa de Misericórdia de Porto Alegre. Porto Alegre, RS, Brasil.
Federal University of Minas Gerais. Belo Horizonte, MG, Brazil.
Universidade de São Paulo. Ribeirão Preto, SP, Brasil.
Fundação Oswaldo Cruz. Instituto de Pesquisa Clínica Evandro Chagas. Laboratório de Pesquisa Clínica em DST e AIDS. Rio de Janeiro, RJ, Brasil.
Westat. Rockville, MD, USA.
Elisabeth Glaser Pediatric AIDS Foundation. Washington, DC, USA.
National Institutes of Health. Eunice Kennedy Shriver National Institute of Child Health and Human Development. Bethesda, MD, USA.
University of California, Los Angeles. David Geffen School of Medicine. Los Angeles, CA, USA.
Abstract
Background: HIV-exposed uninfected (HEU) infants are a growing population with potentially poor health outcomes. We evaluated morbidity and mortality in HEU formula-fed infants enrolled in the NICHD HPTN 040/PACTG 1043 trial. Methods: Infectious morbidity, mortality and undernutrition were evaluated within a cohort of 1000 HEU infants enrolled between April 2004 and April 2010 in Brazil (n = 766) and South Africa (n = 234) as part of the NICHD/HPTN 040 trial of 3 different antiretroviral regimens to decrease intrapartum HIV vertical transmission. Results: Twenty-three percent of infants had at least 1 infectious serious adverse effect. Infants born to mothers with <12 years of education [adjusted odds ratio (AOR), 2.6; 95% confidence interval [CI], 1.2-5.9), with maternal viral load of >1,000,000 copies/mL at delivery (AOR, 9.9; 95% CI, 1.6-63.1) were more likely to have infectious serious adverse effects. At 6 months, the infant mortality rate per 1000 live births overall was 22 ± 2.6, 9.1 ± 1.8 in Brazil and 64.1 ± 3 in South Africa. Undernutrition and stunting peaked at 1 month of age with 18% having a weight-for-age Z score ≤-2, and 22% with height for Z score ≤-2. The likelihood of infant mortality was greater among infants born in South Africa compared with Brazil (AOR, 6.2; 95% CI, 2.5-15.8), high maternal viral load (AOR, 1.7; 95% CI, 1.01-2.9) and birth weight-for-age Z score ≤-2 (AOR, 5.2; 95% CI, 1.8-14.8). Conclusions: There were high rates of undernutrition, stunting and infectious serious adverse effect in this study's formula-fed HEU population. Suppressing maternal HIV viral load during the peripartum period may be a modifiable risk factor to decrease infant mortality.
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