The Linda Kizazi study: a comparison of morbidity and mortality from birth to 2 years between children who are HIV-unexposed and HIV-exposed, uninfected in the era of universal antiretroviral therapy
Background Historically, children who are HIV-exposed, uninfected (CHEU) have been found to have greater morbidity and mortality than children who are HIV-unexposed, uninfected (CHUU). To assess whether this difference persists in the era of universal antiretroviral therapy (ART), we conducted a coh...
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BMJ Publishing Group
2025-01-01
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| Series: | BMJ Global Health |
| Online Access: | https://gh.bmj.com/content/10/1/e015841.full |
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| author | John Kinuthia Dara A Lehman Dalton Wamalwa Brenda Wandika Emily R Begnel Ednah Ojee Judy Adhiambo Eliza Mabele Vincent Ogweno Efrem S Lim Soren Gantt Jennifer Slyker |
| author_facet | John Kinuthia Dara A Lehman Dalton Wamalwa Brenda Wandika Emily R Begnel Ednah Ojee Judy Adhiambo Eliza Mabele Vincent Ogweno Efrem S Lim Soren Gantt Jennifer Slyker |
| author_sort | John Kinuthia |
| collection | DOAJ |
| description | Background Historically, children who are HIV-exposed, uninfected (CHEU) have been found to have greater morbidity and mortality than children who are HIV-unexposed, uninfected (CHUU). To assess whether this difference persists in the era of universal antiretroviral therapy (ART), we conducted a cohort study to compare the risk of acute diarrhoea, respiratory tract infections (RTI), malaria, hospitalisation, and all-cause mortality between Kenyan CHEU and CHUU from birth to 2 years.Methods From December 2018 to March 2020 at Mathare North Health Centre in Nairobi, we recruited pregnant women living with HIV on ART for ≥6 months and pregnant women without HIV from the same community. We followed the mother–infant pairs for 2 years post partum and collected data on symptoms of illness, clinical visits and diagnoses, and infant feeding every 3 months; a self-selected subset of participants also received weekly data collection for up to 1 year. We compared the risk of each outcome between CHEU versus CHUU using HRs from Andersen-Gill (recurrent morbidity outcomes) and Cox proportional hazards (mortality) regression models adjusted for maternal age, marital status and education level.Results Among 187 mother–infant pairs with postpartum data, 86 (46%) infants were CHEU and 101 (54%) were CHUU. All initiated breastfeeding, and 88% of CHEU and 57% of CHUU were exclusively breastfed (EBF) for ≥6 months. There was no significant difference in risk of diarrhoea (HR=0.79, 95% CI 0.52 to 1.22), malaria (HR=0.44, 95% CI 0.16 to 1.21), hospitalisation (HR=1.11, 95% CI 0.30 to 4.14), or mortality (HR=1.87, 95% CI 0.17 to 20.5). However, CHEU had lower risk of any RTI (HR=0.60, 95% CI 0.44 to 0.82) and pneumonia (HR=0.29, 95% CI 0.091 to 0.89).Conclusions CHEU born to women on effective long-term ART experienced similar overall morbidity and mortality as CHUU. However, CHEU had substantially lower risk of pneumonia and other RTI, possibly due to longer EBF in this group. |
| format | Article |
| id | doaj-art-3d1cd276e4ce4d2cbd2bb8d42c8b39a6 |
| institution | Kabale University |
| issn | 2059-7908 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | BMJ Publishing Group |
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| series | BMJ Global Health |
| spelling | doaj-art-3d1cd276e4ce4d2cbd2bb8d42c8b39a62025-01-20T07:15:09ZengBMJ Publishing GroupBMJ Global Health2059-79082025-01-0110110.1136/bmjgh-2024-015841The Linda Kizazi study: a comparison of morbidity and mortality from birth to 2 years between children who are HIV-unexposed and HIV-exposed, uninfected in the era of universal antiretroviral therapyJohn Kinuthia0Dara A Lehman1Dalton Wamalwa2Brenda Wandika3Emily R Begnel4Ednah Ojee5Judy Adhiambo6Eliza Mabele7Vincent Ogweno8Efrem S Lim9Soren Gantt10Jennifer Slyker11Department of Research and Programs, Kenyatta National Hospital, Nairobi, KenyaDivision of Human Biology, Fred Hutchinson Cancer Center, Seattle, Washington, USAPaediatrics and Child Health, University of Nairobi, Nairobi, KenyaPaediatrics and Child Health, University of Nairobi, Nairobi, KenyaGlobal Health, Epidemiology, University of Washington, Seattle, Washington, USAPaediatrics and Child Health, University of Nairobi, Nairobi, KenyaPaediatrics and Child Health, University of Nairobi, Nairobi, KenyaPaediatrics and Child Health, University of Nairobi, Nairobi, KenyaPaediatrics and Child Health, University of Nairobi, Nairobi, KenyaSchool of Life Sciences, Arizona State University, Tempe, Arizona, USAMicrobiologie, Infectiologie et Immunologie, Universite de Montreal Centre de Recherche du CHU St-Justine, Montreal, Quebec, CanadaGlobal Health, Epidemiology, University of Washington, Seattle, Washington, USABackground Historically, children who are HIV-exposed, uninfected (CHEU) have been found to have greater morbidity and mortality than children who are HIV-unexposed, uninfected (CHUU). To assess whether this difference persists in the era of universal antiretroviral therapy (ART), we conducted a cohort study to compare the risk of acute diarrhoea, respiratory tract infections (RTI), malaria, hospitalisation, and all-cause mortality between Kenyan CHEU and CHUU from birth to 2 years.Methods From December 2018 to March 2020 at Mathare North Health Centre in Nairobi, we recruited pregnant women living with HIV on ART for ≥6 months and pregnant women without HIV from the same community. We followed the mother–infant pairs for 2 years post partum and collected data on symptoms of illness, clinical visits and diagnoses, and infant feeding every 3 months; a self-selected subset of participants also received weekly data collection for up to 1 year. We compared the risk of each outcome between CHEU versus CHUU using HRs from Andersen-Gill (recurrent morbidity outcomes) and Cox proportional hazards (mortality) regression models adjusted for maternal age, marital status and education level.Results Among 187 mother–infant pairs with postpartum data, 86 (46%) infants were CHEU and 101 (54%) were CHUU. All initiated breastfeeding, and 88% of CHEU and 57% of CHUU were exclusively breastfed (EBF) for ≥6 months. There was no significant difference in risk of diarrhoea (HR=0.79, 95% CI 0.52 to 1.22), malaria (HR=0.44, 95% CI 0.16 to 1.21), hospitalisation (HR=1.11, 95% CI 0.30 to 4.14), or mortality (HR=1.87, 95% CI 0.17 to 20.5). However, CHEU had lower risk of any RTI (HR=0.60, 95% CI 0.44 to 0.82) and pneumonia (HR=0.29, 95% CI 0.091 to 0.89).Conclusions CHEU born to women on effective long-term ART experienced similar overall morbidity and mortality as CHUU. However, CHEU had substantially lower risk of pneumonia and other RTI, possibly due to longer EBF in this group.https://gh.bmj.com/content/10/1/e015841.full |
| spellingShingle | John Kinuthia Dara A Lehman Dalton Wamalwa Brenda Wandika Emily R Begnel Ednah Ojee Judy Adhiambo Eliza Mabele Vincent Ogweno Efrem S Lim Soren Gantt Jennifer Slyker The Linda Kizazi study: a comparison of morbidity and mortality from birth to 2 years between children who are HIV-unexposed and HIV-exposed, uninfected in the era of universal antiretroviral therapy BMJ Global Health |
| title | The Linda Kizazi study: a comparison of morbidity and mortality from birth to 2 years between children who are HIV-unexposed and HIV-exposed, uninfected in the era of universal antiretroviral therapy |
| title_full | The Linda Kizazi study: a comparison of morbidity and mortality from birth to 2 years between children who are HIV-unexposed and HIV-exposed, uninfected in the era of universal antiretroviral therapy |
| title_fullStr | The Linda Kizazi study: a comparison of morbidity and mortality from birth to 2 years between children who are HIV-unexposed and HIV-exposed, uninfected in the era of universal antiretroviral therapy |
| title_full_unstemmed | The Linda Kizazi study: a comparison of morbidity and mortality from birth to 2 years between children who are HIV-unexposed and HIV-exposed, uninfected in the era of universal antiretroviral therapy |
| title_short | The Linda Kizazi study: a comparison of morbidity and mortality from birth to 2 years between children who are HIV-unexposed and HIV-exposed, uninfected in the era of universal antiretroviral therapy |
| title_sort | linda kizazi study a comparison of morbidity and mortality from birth to 2 years between children who are hiv unexposed and hiv exposed uninfected in the era of universal antiretroviral therapy |
| url | https://gh.bmj.com/content/10/1/e015841.full |
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