A Prospective Cohort Study of Common Childhood Infections in South African HIV-exposed Uninfected and HIV-unexposed Infants

Slogrove, Amy L. MB ChB, MMed, PhD; Esser, Monika M. MB ChB, MMed; Cotton, Mark F. MB ChB, MMed, PhD; Speert, David P. MD; Kollmann, Tobias R. MD, PhD; Singer, Joel PhD; Bettinger, Julie A. PhD

Pediatric Infectious Disease Journal: February 2017 - Volume 36 - Issue 2 - p e38–e44
doi: 10.1097/INF.0000000000001391
HIV Reports

Background: Much evidence of HIV-exposed uninfected (HEU) infant infectious morbidity predates availability of maternal combination antiretroviral therapy and does not control for universal risk factors (preterm birth, low birth weight, suboptimal breastfeeding and poverty).

Methods: This prospective cohort study identified HIV-infected and HIV-uninfected mothers and their newborns from South African community midwife unit. The primary outcome, infectious cause hospitalization or death before 6 months of age, was compared between HEU and HIV-unexposed (HU) infants and classified for type and severity using validated study-specific case definitions. Adjusted odds ratios (aORs) were calculated by logistic regression including stratified analyses conditioned on breastfeeding.

Results: One hundred and seventy-six (94 HEU and 82 HU) mother–infant pairs were analyzed. HIV-infected mothers were older (median, 27.8 vs. 24.7 years; P < 0.01) and HU infants more often breastfed (81/82 vs. 35/94; P < 0.001). Groups were similar for maternal education, antenatal course, household characteristics, birth weight, gestational age and immunizations. The primary outcome occurred in 17 (18%) HEU and 10 (12%) HU infants [aOR, 1.45; 95% confidence interval (CI): 0.44–4.55]. In stratified analysis restricted to breastfed infants, the aOR for hospitalization due to very severe infection or death was 4.2 (95% CI: 1.00–19.2; P = 0.05) for HEU infants. Hospitalization for diarrhea was more common in HEU than HU infants [8/94 (8.5%) vs. 1/82 (1.2%); P = 0.04].

Conclusion: The difference between HEU and HU infants in the probability of infectious cause hospitalization or death in the first 6 months of life was not significant. However, among breastfed infants, severe infectious morbidity occurred more often in HEU than HU infants.

From the *Department of Paediatrics & Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa; School of Population & Public Health, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Department of Pathology, Division of Medical Microbiology Immunology Unit, Stellenbosch University, Stellenbosch, South Africa; §Division of Paediatric Infectious Diseases, Department of Paediatrics & Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa; Department of Pediatrics, Division of Pediatric Infectious Diseases, BC Children’s Hospital and University of British Columbia, and Faculty of Medicine, School of Population & Public Health, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.

Accepted for publication May 04, 2016.

This work was supported by a Major Thematic Grant from the Peter Wall Institute for Advanced Studies, University of British Columbia (grant number: F0906208) and the Canadian Institutes of Health Research Canada-Hope programme (grant number: CH1-106949). Dr. Slogrove was supported by research fellowships from the Canadian Institutes of Health Research Canada-Hope Programme, The Canadian HIV Trials Network International Fellowship and the South African National Health Scholarship Programme. Dr. Bettinger is a Michael Smith Foundation for Health Research Scholar. The authors have no conflicts of interest to disclose.

Address for correspondence: Julie A. Bettinger, PhD, Vaccine Evaluation Center, Department of Pediatrics, Division of Pediatric Infectious Diseases, BC Children’s Hospital and University of British Columbia, A5-173 Child and Family Research Institute, 950 West 28th Avenue, Vancouver, British Columbia V5Y 4H4, Canada. E-mail: jbettinger@cfri.ca.

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