A 12-month Prospective Study of HIV-infected and HIV-uninfected Women and Their Infants in Malawi: Comparative Analysis of Clinical Events and Infant Growth

Marco Floridia Istituto Superiore di Sanità, National Center for Global Health, Rome, Italy;

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Stefano Orlando Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy;

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Mauro Andreotti Istituto Superiore di Sanità, National Center for Global Health, Rome, Italy;

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Robert Mphwere DREAM Program, Community of S. Egidio, Blantyre, Malawi;

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Thom Kavalo DREAM Program, Community of S. Egidio, Blantyre, Malawi;

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Fausto Ciccacci Saint Camillus International University of Health Sciences, Rome, Italy;

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Paola Scarcella Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy;

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Maria Cristina Marazzi Department of Human Sciences, LUMSA University, Rome, Italy

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Marina Giuliano Istituto Superiore di Sanità, National Center for Global Health, Rome, Italy;

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ABSTRACT.

Few studies have compared clinical outcomes in HIV-exposed uninfected (HEU) and HIV-unexposed uninfected (HUU) infants in the current scenario of universal and lifelong maternal antiretroviral therapy (ART). HIV-uninfected and HIV-infected Malawian women receiving ART and their breastfed infants were followed for 12 months postpartum, analyzing the rates of infectious and noninfectious events and assessing infant growth at 6 weeks, 6 months, and 12 months. The cohorts included 227 mothers (70 HIV-negative, 157 HIV-positive) and 235 infants (72 HUU, 163 HEU). No maternal or infant deaths occurred during follow-up. HIV-negative women were less likely to complete follow-up (48.6% versus 91.1%). Mothers with and without HIV had similar rates of both infectious and noninfectious events per person-month. Infants who were HEU, compared with HUU, had higher rates of events of any type, lower respiratory tract infections (LRTI), and noninfectious events. HEU had lower body mass index (BMI) at 6 weeks but did not differ from HUU in all anthropometric measures at 6 and 12 months; in growth between 6 weeks and 12 months; and in occurrence of stunting, underweight, and wasting at 6 weeks, 6 months, and 12 months. During the first year of life, infants who were HEU, compared with HUU, showed a transiently lower BMI and an increased risk of LRTI.

Author Notes

Address correspondence to Marco Floridia, Istituto Superiore di Sanità, National Center for Global Health, Viale Regina Elena 299, 00161 Rome, Italy. E-mail: marco.floridia@iss.it

Financial support: This work was supported by a grant to the Istituto Superiore di Sanità from the Italian Agency for Cooperation and Development through the Global Fund 5% Initiative (grant no. AID 011141/03/04) and is an Italy Independent Activity in the scope of EDCTP2 recorded as Participant State Initiated Activity (PSIA 2019-2072). The funding body had no role in the design of the study and collection, analysis, and interpretation of data or in writing of the manuscript. The corresponding author had full access to all study data and final responsibility for the decision to submit for publication.

Availability of data and materials: The datasets used and analyzed during the current study are available from the corresponding author on reasonable request.

Disclosure: Ethical approval was obtained from the National Health Research Committee in Malawi (approval no. 2085), and written informed consent was obtained from all women participating in the study and from all the parents and/or legal guardians of the infants included in the study.

Authors’ addresses: Marco Floridia, Mauro Andreotti, and Marina Giuliano, Istituto Superiore di Sanità, National Center for Global Health, Rome, Italy, E-mails: marco.floridia@iss.it, mauro.andreotti@iss.it, and marina.giuliano@iss.it. Stefano Orlando and Paola Scarcella, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy, E-mails: stefano.orlando@dreamsantegidio.net and paola.scarcella@uniroma2.it. Robert Mphwere and Thom Kavalo, DREAM Program, Community of S. Egidio, Blantyre, Malawi, E-mails: robertmphwere@gmail.com and thomkavalo123@gmail.com. Fausto Ciccacci, Saint Camillus International University of Health Sciences, Rome, Italy, E-mail: fausto.ciccacci@unicamillus.org. Maria Cristina Marazzi, Department of Human Sciences, LUMSA University, Rome, Italy, E-mail: marazzi@lumsa.it.

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