Abstract
BACKGROUND: Most infants born to women living with HIV are HIV exposed but uninfected exposed infants have poorer growth than HIV-unexposed uninfected children. Few large studies have compared children who are exposed (CHEU) and unexposed (CHUU) in the era of dolutegravir (DTG)-based antiretroviral treatment (ART). SETTING: Longitudinal study of mother-infant CHEU and CHUU pairs in Nairobi and Western Kenya. METHODS: Mother-infant pairs were enrolled at 6 weeks postpartum with 6-monthly growth assessments. We compared longitudinal growth between CHEU and CHUU infants during the first year and assessed biologic and social factors affecting growth [length- and weight-for-age z-scores (LAZ, WAZ) and weight-for-length z-scores (WLZ)] and stunting (LAZ <-2), underweight (WAZ <-2), and wasting (WLZ <-2) from birth to 1 year. RESULTS: Among 2000 infants (1000 CHEU and 1000 CHUU), CHEU infants had significantly lower LAZ at 6 months {-0.165 [95% confidence interval (CI): -0.274 to -0.056], P -value = 0.003} and 12 months (-0.195, 95% CI: -0.294 to -0.095, P -value = 0.0001; n = 1616). CHEU infants had a higher prevalence of stunting at 6 months compared with CHUU infants (prevalence ratio: 1.45, 95% CI: 1.14 to 1.85). Among all children, greater maternal BMI, education, and caregiver-perceived social support were positively associated with growth. Higher maternal and infant comorbidities were associated with growth deficits for CHEU infants. Among CHEU, ART timing (before versus during pregnancy), and ART regimen (dolutegravir -based, efavirenz-based, and protease inhibitor/other) did not affect growth. CONCLUSIONS: Growth deficits among CHEU persist, despite DTG-based ART. Addressing comorbidities, amplifying social support, and education may improve growth outcomes.