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Impact of HIV Exposure on Health Outcomes in HIV-Negative Infants Born to HIV-Positive Mothers in Sub-Saharan Africa

Moraleda, Cinta MD*,†; de Deus, Nilsa PhD*,‡; Serna-Bolea, Celia PhD; Renom, Montse MD*,†; Quintó, Llorenç BSc, MPH; Macete, Eusebio MD, PhD*,§; Menéndez, Clara MD, PhD*,†; Naniche, Denise PhD

JAIDS Journal of Acquired Immune Deficiency Syndromes: February 1st, 2014 - Volume 65 - Issue 2 - p 182–189
doi: 10.1097/QAI.0000000000000019
Clinical Science

Background: Up to 30% of infants may be HIV-exposed noninfected (ENI) in countries with high HIV prevalence, but the impact of maternal HIV on the child's health remains unclear.

Methods: One hundred fifty-eight HIV ENI and 160 unexposed (UE) Mozambican infants were evaluated at 1, 3, 9, and 12 months postdelivery. At each visit, a questionnaire was administered, and HIV DNA polymerase chain reaction and hematologic and CD4/CD8 determinations were measured. Linear mixed models were used to evaluate differences in hematologic parameters and T-cell counts between the study groups. All outpatient visits and admissions were registered. ENI infants received cotrimoxazol prophylaxis (CTXP). Negative binomial regression models were estimated to compare incidence rates of outpatient visits and admissions.

Results: Hematocrit was lower in ENI than in UE infants at 1, 3, and 9 months of age (P = 0.024, 0.025, and 0.012, respectively). Percentage of CD4 T cells was 3% lower (95% confidence interval: 0.86 to 5.15; P = 0.006) and percentage of CD8 T cells 1.15 times higher (95% confidence interval: 1.06 to 1.25; P = 0.001) in ENI vs. UE infants. ENI infants had a lower weight-for-age Z score (P = 0.049) but reduced incidence of outpatient visits, overall (P = 0.042), diarrhea (P = 0.001), and respiratory conditions (P = 0.042).

Conclusions: ENI children were more frequently anemic, had poorer nutritional status, and alterations in some immunologic profiles compared with UE children. CTXP may explain their reduced mild morbidity. These findings may reinforce continuation of CTXP and the need to understand the consequences of maternal HIV exposure in this vulnerable group of children.

*Manhiça Health Research Centre (CISM), Maputo, Mozambique;

Barcelona Centre for International Health Research (CRESIB), Hospital Clínic, Universitat de Barcelona, Barcelona, Spain;

National Institute of Health, Maputo, Mozambique; and

§National Directorate of Health, Ministry of Health, Maputo, Mozambique.

Correspondence to: Cinta Moraleda, MD, Barcelona Centre for International Health Research, Hospital Clínic, Universitat de Barcelona, Rosselló 132, 4-2 08036 Barcelona, Spain (e-mail:

C.S. has received a grant from Spanish Ministry of Health (grant number PI070233). For the remaining authors none were declared. The Manhiça Health Research Centre receives core funding from the Spanish Agency for International Cooperation and Development and the HIV day hospital from the Agencia Catalana de Cooperació al Desenvolupament.

There is no potential conflict of interest. The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.

C. Menendez and D.N. contributed equally.

Presented in part at the 13th European AIDS Conference, October 12–15, 2011, Belgrade, Serbia. Abstract number PE15.6/1.

Received June 03, 2013

Accepted September 22, 2013

© 2014 by Lippincott Williams & Wilkins