Health outcomes among HIV-exposed uninfected infants in Quebec, Canada
Background: HIV exposed uninfected (HEU) infants are at increased risk of adverse health outcomes when compared to unexposed uninfected infants, though the precise cause is yet unknown. Our objective was to study the association between maternal health status at the time of delivery and infant health outcomes.
Methods: HEU infants followed in the CMIS mother-child cohort were eligible for the study. Infants born to mothers with CD4 count < 350 cells/mm3 and detectable viral load (VL) at time of delivery were matched by year of birth, gender and ethnicity to infants born to mothers with delivery CD4 count >350cells/mm3 and undetectable VL (n=133). Data on health outcomes was extracted by chart review, and compared among infant groups defined by maternal health status.
Results: There were no significant differences in gestational age, birthweight, APGAR scores, or growth parameters (weight, length and head circumference) at 6 and 12 month of age, or rate of hospitalization in the first two years of life, among infants born to mothers with delivery CD4 count < 350 cells/mm3 (n=67) vs. >350cells/mm3 (n=66). There was however a higher rate of infection in the first 6 months of life (0.05/person-week vs. 0.02/person-week, p=0.002). Infants born to mothers with detectable VL (n=41) had lower birthweight and mean gestational age as compared to infants of mothers with undetectable VL (n=89) (2914±621g vs. 3201±614g, p=0.01; and 37.9 ±2.83 weeks vs. 38.7 ±2.2 weeks, p=0.055), though there were no differences in their subsequent growth parameters. While there was no difference in the overall rate of infection in the first 6 month of life, there was a significantly higher rate of hospitalization (0.61/person-year vs. 0.22/person-year, p=0.001) in the first two years of life among infants born to mothers with detectable VL.
Conclusions: Maternal CD4 count and VL at delivery may have an impact on health outcomes among HEU infants, with increased rate of infection seen among infants born to mothers with CD4 count< 350 cells/mm3, and higher rate of hospitalization seen among infants born to mothers with detectable VL at the time of delivery. Further work needs to be directed at understanding the contributing factors.
S. Wizman1, S. Valois2, H. Soudeyns2,3,4, N. Lapointe1,2, V. Lamarre1,2, F. Kakkar1,2
1CHU Sainte-Justine, Université de Montreal, Infectious Diseases, Montreal, Canada, 2Centre Maternel et Infantil sur le SIDA (CMIS), CHU Sainte-Justine, Montreal, Canada, 3Université de Montréal, Department of Microbiology, Infectiology & Immunology, Montreal, Canada, 4Unité d'Immunopathologie Virale, Centre de Recherche du CHU Sainte-Justine, Montreal, Canada