Abstract
OBJECTIVE: This study examined growth and development trajectories in Human Immunodeficiency Virus (HIV) exposed children aged 0-3 years, identified key influencing factors, and generated evidence to support early developmental promotion in this population. METHODS: This prospective cohort study enrolled pregnant women who delivered between January 2017 and June 2021 and followed their infants until 3 years of age. Participants were drawn from a mother-to-child HIV transmission cohort established across Guangxi Zhuang Autonomous Region, Yunnan Province, and Xinjiang Uygur Autonomous Region. Chi-square tests were used to compare differences between groups, and generalized estimating equations (GEE) were applied to identify factors influencing growth and nutritional outcomes in HIV-exposed children. RESULTS: The cohort comprised 1,227 mother-child pairs: 411 in the exposed group (HIV-infected mothers) and 816 in the control group (non-HIV-infected mothers). The malnutrition rate among HIV-exposed children in the study regions was 12.00%. Relative to the control group, HIV-exposed children demonstrated significantly lower height and weight gains and a higher prevalence of malnutrition (P<0.05). GEE analysis identified a household per capita monthly income exceeding 3,000 yuan as a protective factor against malnutrition [adjusted odds ratio (aOR)=0.924, 95% confidence interval (CI): 0.877, 0.974], while a maternal history of stillbirth (aOR=1.055, 95% CI: 1.008, 1.104) and neonatal low birth weight (aOR=1.377, 95% CI: 1.267, 1.497) were independent risk factors across all follow-up periods. Female sex was also associated with a modestly elevated risk of malnutrition compared with male sex (aOR=1.048, 95% CI: 1.017, 1.079). CONCLUSIONS: HIV-exposed children in the study regions demonstrated modestly poorer overall growth and development compared with non-exposed peers. These findings underscore the importance of targeted nutritional interventions, early developmental surveillance, and timely correction of growth abnormalities in this vulnerable population.