Growth of children according to maternal and child HIV, immunological and disease characteristics: a prospective cohort study in Kinshasa, DemocraticRepublic of Congo

Background Most HIV-infection in children occurs in sub-Saharan Africa wher e antiretroviral therapy is seldom available. This study compares the growt h progression and retardation of HIV-infected and uninfected children in th e Democratic Republic of Congo (formerly Zaire). It estimates the risk for child growth retardation according to child and maternal immunological fact ors, severity of maternal and child illness, and maternal socioeconomic and marital status. Methods In a prospective cohort study of 258 children born to HIV seroposit ive mothers and 256 children of seronegative mothers in Kinshasa, Congo, th e growth in length, weight, and weight-for-length of infected children (n = 68), uninfected children born to seropositive mothers (n = 190), and uninf ected children born to uninfected mothers (n = 256) was compared. Serologic al, anthropometric and other clinical measures were collected monthly from 3-12 months and bi-monthly during the second year of life. Polymerase chain reaction for HIV was performed on bloods drawn at 2 days and 3 months post partum. Length-for-age, weight-for-age, and weight-for-length mean z-score s against National Center for Health Statistics (NCHS) reference data were calculated, and Cox proportional hazards models were used to estimate the r isk of falling below -2.00 z-scores as a function of child and maternal imm unological. clinical and sociodemographic variables. Results There was no difference in mean length-for-age at birth between HIV -infected (Group I) children, uninfected children of infected mothers (Grou p 2) or Control children, but by 3 months old, HIV-infected children were s horter than both Group 2 and Controls. In weight-for-age and weight-for-len gth, Group 1 infants were lighter and more wasted at birth and onwards. Gro up 2 newborns were lighter than Controls at birth, but by three months they had caught up to Controls in both length and weight and remained the same as Controls thereafter. The odds of falling below -2.00 z-scores by 20 mont hs for length, weight, and weight-for-length for HIV-infected children comp ared to uninfected children were 2.10, 2.84, and 2.56 respectively. Both HI V-infection and associated illnesses were factors associated with child stu nting, underweight and wasting. The mother's age, socioeconomic status, pre sence of father, stage of illness and immune status had no detectable effec t on the child's growth in the first two years of life. Conclusion The HIV-infected children in Congo with no access to antiretrovi ral therapy were stunted, underweight, and wasted compared to same age unin fected children. Both HIV infection and HIV-associated signs and symptoms, not maternal immunological or socioeconomic circumstances, placed children at risk for growth retardation.