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Maternal Perinatal HIV Infection Is Associated With Increased Infectious Morbidity in HIV-exposed Uninfected Infants

Powis, Kathleen M., MD*,†; Slogrove, Amy L., PhD; Okorafor, Ibeawuchi, MD§; Millen, Lily, BA; Posada, Roberto, MD; Childs, Jocelyn, LCSW-R**; Abrams, Elaine J., MD††; Sperling, Rhoda S., MD; Jao, Jennifer, MD§,¶

The Pediatric Infectious Disease Journal: May 2019 - Volume 38 - Issue 5 - p 500–502
doi: 10.1097/INF.0000000000002253
HIV Reports

Background: The aging population of females with perinatally-acquired HIV (PHIV) are having their own children. HIV-exposed uninfected infants (HEU-N) born to women living with non-perinatally-acquired HIV (NPHIV) experience higher infectious morbidity compared with HIV-unexposed infants (HUU). Little is known about the infectious morbidity risk of HIV-exposed uninfected infants (HEU-P) born to PHIV women.

Methods: We evaluated prevalence of infectious cause hospitalizations (ICH) during the first year of life among HEU-P, HEU-N and HUU infants in a United States (U.S) tertiary care center. Maternal HIV status was categorized as PHIV vs. NPHIV vs. HIV-uninfected. Generalized Estimating Equation models were fit to evaluate the association between maternal HIV status and infant ICH.

Results: ICH was evaluated among 205 infants, 28 HEU-P infants, 112 HEU-N infants, and 65 HUU infants. PHIV women were younger compared with NPHIV and HIV-uninfected women (median age 22 years vs. 29 and 23 respectively, p<0.01). Overall, 21% of HEU-P, 4% of HEU-N and 12% of HUU infants experienced at least one ICH event (p<0.01) in the first year of life. After adjusting for confounders, HEU-P infants were at increased ICH risk compared with HEU-N infants [adjusted odds ratio (aOR)=7.45, 95% Confidence Interval (CI):1.58-35.04]. In sub-group analysis of HEU infants, excluding HUU infants, this relationship persisted after adjustment for maternal CD4 and HIV RNA level (aOR=10.24, 95% CI:1.66-63.31)

Conclusions: In a small U.S. cohort, HEU-P infants experienced increased ICH risk. Differences in intrauterine environments, social factors, or access to care may be important factors to assess in future larger studies.

*Departments of Internal Medicine and Pediatrics, Massachusetts General Hospital

Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts

Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa

§Department of Medicine

Department of Obstetrics, Gynecology, and Reproductive Science

Department of Pediatrics

**Department of Social Work, Icahn School of Medicine at Mount Sinai, New York, New York

††ICAP at Columbia, Mailman School of Public Health and College of Physicians and Surgeons, Columbia University, New York, New York.

Accepted for publication November 5, 2018.

This study was supported by the Icahn School of Medicine at Mount Sinai Dean’s Office and ConduITS—the Institutes for Translational Sciences (Clinical and Translational Science Award) (UL1TR001433).

A.L.S. received salary support from the Fogarty International Center of the National Institutes of Health (1K43TW010683-01). E.J.A. has participated on advisory boards for ViiV and Merck. J.J. received salary support from the National Institute of Child Health and Human Development 1K23HD070760-01A1 during the preparation of this article. The other authors have no conflicts of interest to disclose.

Address for correspondence: Kathleen M. Powis, MD, MPH, MBA, Massachusetts General Hospital, 125 Nashua Street, Office 8426, Boston, MA 02114. E-mail:

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