Background: The risk of HIV-1 infection is high among breast-fed children in sub-Saharan Africa. Monitoring the nutritional status can provide useful information to determine the effect of HIV infection and breast-feeding on child growth and development. We longitudinally assessed the nutritional status and determined its association with HIV infection and breast-feeding among Malawian children.
Methods: We analyzed data from 2 clinical trials to prevent mother-to-child transmission of HIV in Malawi. These trials were conducted during 2000–2003 before the current guidelines were implemented to breast-feed exclusively during the first 6 months and wean thereafter. The nutritional status of children was measured up to age 24 months, using z-scores. Age-specific differences in length-for-age (L/A), weight-for-age (W/A), and weight-for-length (W/L) were compared stratifying by gender and HIV infection status. Multivariable models examined the mean change in z-scores controlling for breast-feeding and other factors.
Results: In this analysis, 1589 children were included. Boys had significantly lower L/A scores and became stunted (z-score −<2 standard deviations) earlier than girls. HIV-infected children had significantly lower mean L/A and W/A z-scores than HIV-uninfected children and became stunted and underweight at an earlier age. In multivariable analysis not being breast-fed and being HIV infected were significantly (P < 0.001) associated with decreases in mean L/A, W/A, and W/L z-scores.
Conclusions: This study shows the impact of infant HIV infection on growth and supports the critical importance of breast-feeding. Mother-to-child transmission of HIV programs should endeavor to preserve breast-feeding and find alternative measures to prevent postnatal HIV transmission.
From the *Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; †Departments of Obstetrics and Gynecology and Pediatrics, College of Medicine, University of Malawi, Blantyre, Malawi (G.K.: deceased); and ‡College of Medicine–Johns Hopkins University Research Project, Blantyre, Malawi.
Accepted for publication December 2, 2009.
Supported by funds from the Fogarty International Center, National Institutes of Health (AIDS FIRCA Award # 5R03TW01199 and Supplement), and the Doris Duke Charitable Foundation, New York.
Address for correspondence: Taha E. Taha, MB BS, PhD, Rm E7138, Department of Epidemiology, Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205. E-mail email@example.com.
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