Study finds no significant differences in growth between children exposed to HIV in the womb and those unexposed

A new study led by researchers at Oxford Population Health has found no significant differences in growth up to two years of age between children who were exposed to HIV during pregnancy but remained uninfected and those born to mothers without HIV. The study is published in eClinicalMedicine.

The study compared the growth of 398 children at one year old and 286 children at two years old in Soweto, South Africa. Among them, 143 and 82 children respectively were HIV-exposed but uninfected (CHEU), while 255 and 204 were HIV-unexposed and uninfected (CHUU). The researchers assessed growth indicators using World Health Organization (WHO) Child Growth Standards: length-for-age, weight-for-age, weight-for-length, and head circumference-for-age.

Key findings:

• CHEU tended to have slightly lower growth scores, these differences were not statistically significant after adjusting for maternal and socioeconomic factors;
• At one year of age, stunting (defined as length-for-age more than two standard deviations below the WHO standard mean) affected 29% of HIV-exposed and 19% of HIV-unexposed children, while by two years the rates were 19% and 21%, respectively;
• The prevalence of underweight (weight-for-age more than two standard deviations below the mean) and wasting (weight-for-length more than two standard deviations below the mean) was similar across groups, though children exposed to HIV had a lower risk of overweight (weight-for-length more than two standard deviations above the mean) at two years old.

Anna Carlqvist, first author of the study and DPhil student in Oxford Population Health, said ‘Our findings show that children who were exposed to HIV during pregnancy, but not infected, grow similarly to those born to HIV-negative mothers in the first two years of life. However, we also observed high rates of stunting in both groups, highlighting the need for public health interventions to improve early childhood growth.’

The study was conducted as part of the INTERBIO-21st cohort, which followed mothers and children from early pregnancy through early childhood. The women living with HIV received antiretroviral therapy (ART) during pregnancy in line with South African guidelines at the time.

Joris Hemelaar, Associate Professor at Oxford Population Health and senior author of the study calls for further research to identify which children are most at risk of poor growth outcomes, especially in regions where both HIV exposure and malnutrition are prevalent.

The research was funded by the Gates Foundation and the Oxford–MRC Doctoral Training Partnership.