Abstract
OBJECTIVE: Increased mortality and morbidity has been observed among children who are HIV-exposed, uninfected (CHEU). It is unknown if health disparities remain despite promotion of exclusive breastfeeding and adoption of universal combination antiretroviral therapy (cART) for pregnant women. DESIGN: We conducted a longitudinal cohort study among pregnant women with and without HIV [Zambia Infant Cohort (ZICS)] with the primary goal to measure the morbidity/mortality experienced by CHEU in first 6 months of life, and secondarily whether such disparities could be explained by timing of cART initiation or elevated maternal immune activation. METHODS: Pregnant women with/without HIV (1 : 1) were enrolled prior to 26 weeks gestation by ultrasound and assessed twice antenatally. Infants were seen at birth, 6 days, 6, 10, 14, 20, and 24 weeks of age and assessed for illnesses, sick visits/hospitalizations, infant feeding, immunizations, and co-trimoxazole compliance. RESULTS: From 1276 livebirths, there were 36 deaths and 89 hospitalizations over 6 months. Preconception cART uptake was 73%, and majority of pregnant women with HIV had suppressed viral loads at enrollment. There was no difference in hospitalization or death rates for CHEU as compared to HIV-unexposed children [incidence rate ratio (IRR) 1.27, 95% CI 0.79-2.04, P = 0.33]. This did not shift after adjusting for maternal immune activation prematurity or small for gestational age (SGA). Exclusive breastfeeding reduced risk of hospitalization by 43%. CONCLUSION: In this setting of moderate cART uptake, we found no evidence of increased hospitalizations or deaths among CHEU. We conclude that the observed increased morbidity among CHEU can be effectively mitigated through early initiation of cART and exclusive breastfeeding.