Maternal and infant factors associated with failure to thrive in children with vertically transmitted human immunodeficiency virus-1 infection: The prospective, (PC2)-C-2 human immunodeficiency virus multicenter study
Tl. Miller et al., Maternal and infant factors associated with failure to thrive in children with vertically transmitted human immunodeficiency virus-1 infection: The prospective, (PC2)-C-2 human immunodeficiency virus multicenter study, PEDIATRICS, 108(6), 2001, pp. 1287-1296
Objective. Many children with human immunodeficiency virus-1 (HIV-1) have c
hronic problems with growth and nutrition, yet limited information is avail
able to identify infected children at high risk for growth abnormalities. U
sing data from the prospective, multicenter (PC2)-C-2 HIV study, we evaluat
ed the relationships between maternal and infant clinical and laboratory fa
ctors and impaired growth in this cohort.
Methods. Children of HIV-1-infected women were enrolled prenatally or withi
n the first 28 days of life. Failure to thrive (FTT) was defined as an age-
and sex-adjusted weight z score less than or equal to -2.0 SD. Maternal ba
seline covariates included age, race, illicit drug use, zidovudine use, CD4
(+) T-cell count, and smoking. Infant baseline predictors included sex, rac
e, CD4(+) T-cell count, Centers for Disease Control stage, HIV-1 RNA, antir
etroviral therapy, pneumonia, heart rate, cytomegalovirus, and Epstein-Barr
virus infection status.
Results. The study cohort included 92 HIV-1-infected and 439 uninfected chi
ldren. Infected children had a lower mean gestational age, but birth weight
s, lengths, and head circumferences in the 2 groups were similar. Mothers o
f growth-delayed infants were more likely to have smoked tobacco and used i
llicit drugs during pregnancy. In repeated-measures analyses of weight and
length or height z scores, the means of the HIV-1-infected group were signi
ficantly lower at 6 months of age (P < .001) and remained lower throughout
the first 5 years of life. In a multivariable Cox regression analysis, FTT
was associated with a history of pneumonia (relative risk [RR] = 8.78; 95%
confidence interval [CI]: 3.59-21.44), maternal use of cocaine, crack, or h
eroin during pregnancy (RR = 3.17; 95% CI: 1.51-6.66), infant CD4(+) T-cell
count z score (RR = 2.13 per 1 SD decrease; 95% CI: 1.25-3.57), and any an
tiretroviral therapy by 3 months of age (RR = 2.77; 95% CI: 1.16-6.65). Aft
er adjustment for pneumonia and antiretroviral therapy, HIV-1 RNA load rema
ined associated with FTT in the subset of children whose serum was availabl
e for viral load analysis.
Conclusion. Clinical and laboratory factors associated with FTT among HIV-1
-infected children include history of pneumonia, maternal illicit drug use
during pregnancy, lower infant CD4(+) T-cell count, exposure to antiretrovi
ral therapy by 3 months of age (non-protease inhibitor), and HIV-1 RNA vira
l load.