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Growth failure as a prognostic indicator of mortality in pediatric HIV infection
R Berhane1, D Bagenda, L Marum
1New England Medical Center, Tufts University, Boston, Massachusetts, USA.
Insights
Perinatally acquired human immunodeficiency virus (HIV) infection causes significant growth failure in infants. Poor nutritional status in HIV-infected infants is strongly linked to increased mortality risk before age two.
Area of Science:
- Pediatrics
- Infectious Diseases
- Global Health
Background:
- Perinatal HIV transmission poses a significant global health challenge.
- Understanding the impact of HIV on infant development is crucial for effective interventions.
Purpose of the Study:
- To assess the impact of perinatally acquired HIV on infant somatic growth.
- To investigate the correlation between nutritional status and mortality in HIV-infected infants.
Main Methods:
- Prospective cohort study of infants born to HIV-1 seropositive and seronegative mothers in Kampala, Uganda.
- Follow-up of 84 HIV-infected and control infants for 25 months.
Main Results:
- HIV-infected infants exhibited significantly lower weight-for-age and length-for-age.
- Mortality by age two was 54% in HIV-infected infants versus 1.6-5.6% in controls.
- A Z-score below -1.5 in the first year increased mortality risk nearly fivefold.
Conclusions:
- Perinatal HIV infection leads to early and progressive growth failure.
- Growth failure severity correlates with increased mortality risk.
- Further research on nutritional interventions is warranted.
Objective:
To study the effect of perinatally acquired human immunodeficiency virus (HIV) on somatic growth and examine the relationship of nutritional status to mortality in HIV-infected infants.
Method:
Pregnant women attending the antenatal clinic at Mulago hospital in Kampala, Uganda, were enrolled. All live-born babies born to HIV-1 seropositive (HIV+) women, and to every fourth age-matched HIV-1 seronegative (HIV-) woman, were followed for 25 months.
Results:
The mean weight-for-age and length-for-age curves of HIV+ children were significantly lower than those of HIV- controls and seroeverters. Forty-five (54%) of the 84 HIV+ infants died before their second birthday, as compared with a 1.6% and 5.6% mortality in HIV- and seroeverters. HIV+ infants with an average weight-for-age Z-score below -1.5 in the first year of life have a nearly fivefold risk of dying before 25 months of age compared with noninfected controls.
Conclusion:
Perinatally acquired HIV infection is associated with early and progressive growth failure. The severity of growth failure is associated with an increased risk of mortality. The effect of early, aggressive nutritional intervention in delaying HIV progression and mortality should be evaluated by controlled intervention studies.