Browsing by Author "Morden, Erna"

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    Open Access
    A description of HIV-exposed uninfected infants in the IeDEA Southern Africa Cohort and an examination of growth outcomes
    (2014) Morden, Erna; Davies, Mary-Ann
    Since the successful use of antiretroviral therapy for the prevention of mother-to-child transmission of human immunodeficiency virus (HIV), there has been a steady increase in the number of infants born to HIV-infected mothers who remain uninfected. The characteristics of these HIV-exposed uninfected infants are not well known, including growth and other health outcomes. The International Epidemiologic Databases to Evaluate AIDS Southern Africa (IeDEA-SA) research strategy 2011-2016 includes specific studies in pregnant women, infants, children and adolescents. This study addresses one of the IeDEA-SA objectives, namely to establish and describe a sub-cohort of HIV-infected pregnant women and their exposed infants. Part A, the protocol, includes background information on sites contributing to this cohort of HIV-exposed uninfected (HEU) infants. It also details the aims, objectives and methodology of this study. Part B, the literature review, discusses what is known about HIV-exposed uninfected infants to date. It includes maternal disease factors, the use of antiretroviral therapy and the association between feeding modality and growth, focussing on studies conducted on the African continent. Part C, the manuscript, details the methodology, results and their interpretation of longitudinal analysis of growth among HEU infants in the IeDEA-SA collaboration. This cohort of HEU infants included 2621 infants from two South African sites. The median birth WAZ was -0.65 (IQR -1.46; 0.0), 51% were male and there was a median of 2 visits per infant. The feeding modalities practised were as follows: 0.5% exclusive breastfeeding, 7.9% unknown breastfeeding exclusivity, 78.6% mixed breastfeeding and 10.6% formula feeding. Mothers with a CD4 <200 cells/μl delivered infants with a lower birth WAZ (adjusted ß -0.253 [95% CI -0.043; -0.072], p = 0.006) compared to mothers with a CD4 ≥500 cells/≧l. Similarly, iv mothers who did not receive antiretroviral (ARVs) drugs delivered infants with a lower birth WAZ (adjusted ß -0.49 [95% CI -0.78; -0.20], p = 0.001) compared to mothers who received antenatal ARVs. Antenatal maternal ARVs and CD4 cell count did not have an effect on postnatal growth. Mixed effects models using maximum likelihood estimation for the longitudinal analysis of growth showed that exposure to breast milk positively influenced growth, albeit the effect was small. Infants with a birth weight <2 500g (ß 0.069 [95% CI 0.061; 0.078], p <0.0001) experienced faster growth within the first 28 weeks of life compared to infants with a birth weight ≥2 500g. In this cohort of South African HEU infants, less severe maternal disease and the use of ARVs positively impacted birth weight. Mixed feeding was common, and any breastfeeding may have a positive effect on longitudinal growth.
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    Open Access
    Growth of HIV-exposed uninfected infants in the first 6 months of life in South Africa: The IeDEA-SA collaboration
    (Public Library of Science, 2016) Morden, Erna; Technau, Karl-Günter; Giddy, Janet; Maxwell, Nicola; Keiser, Olivia; Davies, Mary-Ann
    BACKGROUND: HIV-exposed uninfected (HEU) infants are a growing population in sub-Saharan Africa especially with the increasing coverage of more effective prevention of mother-to-child transmission (PMTCT) antiretroviral therapy regimens. This study describes the characteristics of South African HEU infants, investigates factors impacting birth weight and assesses their growth within the first 28 weeks of life. METHODS: This is a retrospective cohort based on routine clinical data from two South African PMTCT programmes. Data were collected between 2007 and 2013. Linear regression assessed factors affecting birth weight-for-age z-scores (WAZ) while growth (longitudinal WAZ) was assessed using mixed effects models. RESULTS: We assessed the growth of 2621 HEU infants (median birth WAZ was -0.65 (IQR -1.46; 0.0) and 51% were male). The feeding modalities practised were as follows: 0.5% exclusive breastfeeding, 7.9% breastfeeding with unknown exclusivity, 0.08% mixed breastfeeding and 89.2% formula feeding. Mothers with CD4 <200 cells/μl delivered infants with a lower birth WAZ (adjusted ß -0.253 [95% CI -0.043; -0.072], p = 0.006) compared to mothers with aCD4 ≥500 cells/μl. Similarly, mothers who did not receive antiretroviral drugs delivered infants with a lower birth WAZ (adjusted ß -0.39 [95% CI -0.67; -0.11], p = 0.007) compared to mothers who received antenatal antiretrovirals. Infants with a birth weight <2 500g (ß 0.070 [95% CI 0.061; 0.078], p <0.0001) experienced faster growth within the first 28 weeks of life compared to infants with a birth weight ≥2 500g. Infants with any breastfeeding exposure experienced slower longitudinal growth compared to formula fed infants (adjusted ß -0.012 [95% CI 0.021; -0.003], p = 0.011). CONCLUSION: Less severe maternal disease and the use of antiretrovirals positively impacts birth weight in this cohort of South African HEU infants. Formula feeding was common with breastfed infants experiencing marginally slower longitudinal growth.