Abstract
Objective
To study the outcome of HIV exposed infants in terms of mortality, morbidity, nutritional status and HIV infection status.
Methods
Retrospective analysis of data on 162 HIV exposed infants registered at Regional Pediatric Center for HIV, Delhi and meeting the inclusion criteria, was done.
Results
Median age at presentation was 6 wk. 17.4% mothers were on ART while 44.1% received NVP prophylaxis. 61.7% babies received NVP prophylaxis. Thirty-three percent of infants were symptomatic at presentation. Feeding strategy followed was breast-feeding in 18.7%, replacement feeding 71.6% and mixed feeding 9.7%. At presentation, 50.6% infants were wasted, 48.8% stunted and 39.4% had microcephaly. A progressive increase in proportion of children with under-nutrition, stunting and microcephaly was noted with increasing age at presentation. Of the enrolled infants, 81 (50%) were alive and under follow-up. Among these, HIV infection was excluded in 65 infants (80.2% of those alive, 40.1% of the cohort). Thirty-four (21%) infants died and 47 (29%) were lost to follow-up. HIV infection was diagnosed in 24 (14.8%, 14 definite, 10 presumed). Of these 13 were alive and on ART, while 11 died. HIV status was not ascertained for the infants lost to follow-up and 23 infants who died.
Conclusions
HIV infection is being under-diagnosed during pregnancy. Exposed infants have a high mortality and high prevalence of malnutrition. There is an urgent need for standardizing care of exposed infants to promote follow-up and prevent mortality by offering feeding counseling and ensuring early infection detection.
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References
Annual Report 2009–2010. Department of AIDS Control, Min. of Health and Family Welfare, Govt. of India. http://www.nacoonline.org
Newell ML, Coovadia H, Cortina-Borja M, Rollins N, Gaillard P, Dabis F. For the Ghent International AIDS Society (IAS) working group on HIV infection in women and children. Mortality of infected and uninfected infants born to HIV-infected mothers in Africa: a pooled analysis. Lancet. 2004;364:1236–43.
Nathan LM, Nerlander LM, Dixon JR, et al. Growth, morbidity, and mortality in a Cohort of institutionalized HIV-1-infected African children. JAIDS. 2003;34:237–41.
Mussi-Pinhata MM, Freimanis L, Yamamoto AY, et al. Infectious disease morbidity among young HIV exposed but uninfected infants in Latin American and Caribbean countries: The National Institute of Child Health and Human Development International Site Development Initiative Perinatal Study. Pediatrics. 2007;119:e694–704.
Devi GPN, Shenbagavalli R, Ramesh K, Rathinam SN, Swaminathan S. Rapid progression of HIV infection in infancy. Indian Pediatr. 2009;46:53–6.
Shah I. Age related clinical manifestations of HIV infection in Indian children. J Trop Pediatr. 2005;51:300–3.
Sinha A, Roy M. An ICMR task force study of prevention to parent to child transmission (PPTCT) service delivery in India. Indian J Public Health. 2008;52:200–2.
Kagaayi J, Gray HR, Brahmbhatt H, et al. Survival of infants born to HIV positive mothers, by feeding modality, in Rakai, Uganda. PLoS One. 2008;3:e3877.
Thior I, Lockman S, Smeaton LM, MASHI study team, et al. Breast feeding plus infant zidovudine prophylaxis for 6 months vs formula feeding plus infant zidovudine for 1 month to reduce mother to child transmission in Botswana: a randomized trial, the MASHI study. JAMA. 2006;296:794–805.
WHO rapid advice: Revised WHO principles and recommendations on infant feeding in the context of HIV—November 2009.
Kuhn L, Sinkala M, Kansasa C, et al. High uptake of exclusive breast feeding and reduced early postnatal HIV transmission. PLoS One. 2007;2:e1363.
Coovadia HM, Rollins NC, Bland RM, et al. Mother to child transmission of HIV-1 infection during exclusive breastfeeding in the first 6 months of life: an intervention cohort study. Lancet. 2007;369:1107–16.
Isanaka S, Duggan C, Fawzi WW. Patterns of postnatal growth in HIV-infected and HIV-exposed infants. Nutr Rev. 2009;67:343–59.
Bobat R, Coovadia H, Moodley D, Coutsoudis A, Gouws E. Growth in early infancy in a cohort of infants born to HIV-1 infected women from Durban, south Africa. Ann Trop Paediatr. 2001;21:203–10.
Agostoni C, Zuccotti GV, Giovannini M, et al. Growth in first two years of uninfected children born to HIV sero-positive mothers. Arch Dis Child. 1998;79:175–8.
Agostini C, Riva E, Gianni ML, Silano M, Giovannini M, Zuccotti GV. Anthropometric indicators of human immunodeficiency virus infection in infants with early and late symptoms in the first months of life. Eur J Pediatr. 1998;157:811–3.
Moye Jr J, Rich KC, Kalish LA, et al. Natural history of somatic growth in infants born to women infected by human immunodeficiency virus. Women and Infants Transmission Study Group. J Pediatr. 1996;128:58–69.
Saavedra JM, Henderson RA, Perman JA, Hutton N, Livingston RA, Yolken RH. Longitudinal assessment of growth in children born to mothers with human immunodeficiency virus infection. Arch Pediatr Adolesc med. 1995;149:497–502.
Pollack H, Kuchuk A, Cowan L, et al. Neurodevelopment, growth and viral load in HIV infected infants. Brain Behav Immun. 1996;10:298–312.
Lepage P, Msellati P, Hitimana DG, et al. Growth of human immunodeficiency type-1 infected and uninfected children: a prospective cohort study in Kigali, Rwanda 1988 to 1993. Pediatr Infect Dis J. 1996;15:479–85.
Zijenah L, Mbizvo MT, Kasule J, et al. Mortality in the first two years among infants born to human immunodeficiency virus infected women in Harare, Zimbabwe. J Infect Dis. 1998;178:109–13.
Simpson BJ, Shapiro ED, Andiman WA. Prospective cohort study of children born to human immunodeficiency virus-infected mothers, 1985 through 1997: trends in the risk of vertical transmission, mortality and acquired immunodeficiency syndrome indicator diseases in the era before highly active antiretroviral therapy. Pediatr Infect dis J. 2000;19:618–24.
Newell ML, Coovadia H, Cortina-Borja M, Rollins N, Gaillard P, Dabis F. Mortality of infected and uninfected infants born to HIV-infected mothers in Africa: a pooled analysis. Lancet. 2004;364:1236–43.
Brahmbhatt H, Kigozi G, Wabwire-Mangen F, et al. Mortality in HIV-infected and uninfected children of HIV-infected and uninfected mothers in rural Uganda. J acquir Immune Defic Syndr. 2006;41:504–8.
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Seth, A., Chandra, J., Gupta, R. et al. Outcome of HIV Exposed Infants: Experience of a Regional Pediatric Center for HIV in North India. Indian J Pediatr 79, 188–193 (2012). https://doi.org/10.1007/s12098-011-0532-8
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DOI: https://doi.org/10.1007/s12098-011-0532-8