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  • 1
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    Online Resource
    Lower academic performance among children with perinatal HIV exposure in Botswana
    Wiley ; 2023
    In:  Journal of the International AIDS Society Vol. 26, No. S4 ( 2023-10)
    Details
    In: Journal of the International AIDS Society, Wiley, Vol. 26, No. S4 ( 2023-10)
    Abstract: Studies have reported a higher risk of suboptimal neurodevelopment among children who are HIV‐exposed uninfected (HEU) compared to children HIV‐unexposed uninfected (HUU). Actual academic performance among school‐aged children by HIV exposure status has not been studied. Methods Academic performance in Mathematics, Science, English, Setswana and overall among children enrolled in the Botswana‐based FLOURISH study who were attending public primary school and ranging in age from 7.1 to 14.6 years were compared by HIV exposure status using a Cochran‐Mantel‐Haenszel test. Lower academic performance was defined as a grade of “C” or lower (≤60%). Unadjusted and adjusted logistic regression models were fit to assess for an association between HIV exposure and lower academic performance. Results Between April 2021 and December 2022, 398 children attending public primary school enrolled in the FLOURSH study, 307 (77%) were HEU. Median age was 9.4 years (IQR 8.9–10.2). Only 17.9% of children HEU were breastfeed versus 100% of children HUU. Among children HEU, 80.3% had foetal exposure to three‐drug antiretroviral treatment, 18.7% to zidovudine only and 1.0% had no antiretroviral exposure. Caregivers of children HEU were older compared to caregivers of children HUU (median 42 vs. 36 years) and more likely to have no or primary education only (15.0% vs. 1.1%). In unadjusted analyses, children HEU were more likely to have lower overall academic performance compared to their children HUU (odds ratio [OR]: 1.96 [95% confidence interval (CI): 1.16, 3.30] ), and lower performance in Mathematics, Science and English. The association was attenuated after adjustment for maternal education, caregiver income, breastfeeding, low birth weight and child sex (aOR: 1.86 [95% CI: 0.78, 4.43]). Conclusions In this Botswana‐based cohort, primary school academic performance was lower among children HEU compared to children HUU. Biological and socio‐demographic factors, including child sex, appear to contribute to this difference. Further research is needed to identify modifiable contributors, develop screening tools to identify the risk of poor academic performance and design interventions to mitigate risk.
    Type of Medium: Online Resource
    ISSN: 1758-2652 , 1758-2652
    URL: Issue
    URL: Article
    DOI: 10.1002/jia2.v26.S4
    DOI: 10.1002/jia2.26165
    Language: English
    Publisher: Wiley
    Publication Date: 2023
    detail.hit.zdb_id: 2467110-1
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  • 2
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    Hypertensive disorders of pregnancy and HIV: analysis of a province-wide cohort during 2018 and 2019
    Ovid Technologies (Wolters Kluwer Health) ; 2023
    In:  AIDS Vol. 37, No. 7 ( 2023-06-1), p. 1047-1055
    Details
    In: AIDS, Ovid Technologies (Wolters Kluwer Health), Vol. 37, No. 7 ( 2023-06-1), p. 1047-1055
    Abstract: We evaluated the prevalence of de novo hypertensive disorders of pregnancy (dnHDP) in pregnant people with HIV (PPHIV) in the Western Cape Province, South Africa in 2018–2019 by HIV and antiretroviral therapy (ART) status. Methods: All people with a pregnancy outcome from 1 January 2018 to 31 December 2019 in the Western Cape Provincial Health Data Centre (WCPHDC) were included. The WCPHDC integrates data from multiple electronic platforms according to unique identifiers. dnHDP was classified by ICD-10 code or first-time prescription of antihypertensive drugs less than 140 days before delivery. Pregnant people with preexisting hypertension without superimposed preeclampsia/eclampsia were not considered to have dnHDP. Adjusted prevalence ratios (aPR) for dnHDP by HIV/ART status were calculated using Poisson regression with robust variance. Results: Among 180 553 pregnant people studied, 13 677 (7.6%) had dnHDP and 33 978 (18.8%) were PPHIV. Among PPHIV, 11.3% ( N  = 3827) had no evidence of ART, 59.7% ( N  = 20 283) initiated ART preconception and 29.0% ( N  = 9868) had ART initiated during pregnancy. Compared to those without HIV (7.7%), dnHDP prevalence was lower in PPHIV with preconception [6.9%; aPR 0.78; 95% confidence interval (CI) 0.74–0.83] or pregnancy-initiated ART (7.0%; aPR 0.83; 95% CI 0.75–0.92) and higher in PPHIV without ART (9.8%; aPR 1.17; 95% CI 1.06–1.29) adjusted for maternal age, multiparity, multigestation pregnancy and preexisting hypertension. ART duration by delivery of at least 100 weeks versus pregnancy-initiated ART of 20– 〈 40 weeks was protective (aPR 0.88; 95% CI 0.78–0.98). Conclusions: In the context of universal ART, these findings are reassuring for most PPHIV. ART was not associated with increased dnHDP prevalence and longer ART duration was protective.
    Type of Medium: Online Resource
    ISSN: 0269-9370 , 1473-5571
    URL: Article
    DOI: 10.1097/QAD.0000000000003506
    RVK:
    XA 16838
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2023
    detail.hit.zdb_id: 2012212-3
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  • 3
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    Standardized Definitions of In Utero Human Immunodeficiency Virus and Antiretroviral Drug Exposure Among Children
    Oxford University Press (OUP) ; 2022
    In:  Clinical Infectious Diseases Vol. 75, No. 2 ( 2022-08-25), p. 347-355
    Details
    In: Clinical Infectious Diseases, Oxford University Press (OUP), Vol. 75, No. 2 ( 2022-08-25), p. 347-355
    Abstract: In countries with high human immunodeficiency virus (HIV) prevalence, up to 30% of pregnant women are living with HIV, with fetal exposure to both HIV and antiretroviral therapy during pregnancy. In addition, pregnant women without HIV but at high risk of HIV acquisition are increasingly receiving HIV preexposure antiretroviral prophylaxis (PrEP). Investments are being made to establish and follow cohorts of children to evaluate the long-term effects of in utero HIV and antiretroviral exposure. Agreement on a key set of definitions for relevant exposures and outcomes is important both for interpreting individual study results and for comparisons across cohorts. Harmonized definitions of in utero HIV and antiretroviral drug (maternal treatment or PrEP) exposure will also facilitate improved classification of these exposures in future observational studies and clinical trials. The proposed definitions offer a uniform approach to facilitate the consistent description and estimation of effects of HIV and antiretroviral exposures on key child health outcomes.
    Type of Medium: Online Resource
    ISSN: 1058-4838 , 1537-6591
    URL: Article
    DOI: 10.1093/cid/ciab974
    RVK:
    XA 10000
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2022
    detail.hit.zdb_id: 2002229-3
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  • 4
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    Severe acute malnutrition outcomes for children of South African compared to foreign-born parents admitted to a rural regional hospital in South Africa: a retrospective cohort study
    Oxford University Press (OUP) ; 2022
    In:  Journal of Tropical Pediatrics Vol. 68, No. 6 ( 2022-10-06)
    Details
    In: Journal of Tropical Pediatrics, Oxford University Press (OUP), Vol. 68, No. 6 ( 2022-10-06)
    Abstract: Children of foreign-born parents with vulnerable legal status, limited economic rights and exclusion from national social interventions may be at higher risk for severe acute malnutrition (SAM). We evaluated the relationship between parent status (foreign-born vs. South African) and outcomes for children with SAM admitted to a rural regional hospital in the Western Cape, South Africa. Methods A retrospective cohort study was conducted including children & lt;5 years admitted to Worcester Provincial Hospital during 2015–17 with SAM (WHO weight-for-height Z score & lt;−3, presence of nutritional oedema, mid-upper-arm-circumference of & lt;11.5 cm or visible severe wasting). Exposures, including parent status, and outcomes including in-hospital death were determined from hospital and regional dietician records. Results Of 95 children included, 31 (33%) were of foreign-born and 64 (67%) of South African parents. Median (interquartile range) age at admission was 12 (8–18) vs. 10 (8–13) months in children of South African vs. foreign-born parents with no difference in preterm birth, concurrent illnesses or admission duration. Age, HIV status and breastfeeding practices were no different in foreign-born compared to South African mothers. In-hospital deaths occurred in 3/64 (5%) and 6/31 (19%) children of South African vs. foreign-born parents (p = 0.01). Children of foreign-born compared to South African parents had an odds ratio of 4.88 (95% CI 1.13–21.06) for in-hospital SAM-associated mortality. Conclusion In this rural setting, 33% of children admitted with SAM were of foreign-born parents and experienced in-hospital SAM-associated mortality at least four times higher than children of South African parents. This illustrates the extreme vulnerability of these children.
    Type of Medium: Online Resource
    ISSN: 1465-3664
    URL: Article
    DOI: 10.1093/tropej/fmac097
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2022
    detail.hit.zdb_id: 1497447-2
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  • 5
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    Maternal and birth outcomes in pregnant people with and without HIV in the Western Cape, South Africa: population-based cohort study
    Ovid Technologies (Wolters Kluwer Health) ; 2023
    In:  AIDS
    Details
    In: AIDS, Ovid Technologies (Wolters Kluwer Health)
    Abstract: We evaluated associations of HIV and antiretroviral therapy (ART) with birth and maternal outcomes at a province-wide-level in the Western Cape, South Africa, in a recent cohort before dolutegravir-based first-line ART implementation. Methods: This retrospective cohort study included pregnant people delivering in 2018-2019 with data in the Western Cape Provincial Health Data Centre which integrates individual-level data on all public sector patients from multiple electronic platforms using unique identifiers. Adverse birth outcomes (stillbirth, low birth weight (LBW), very LBW (VLBW)) and maternal outcomes (early and late pregnancy-related deaths, early and late hospitalizations) were compared by HIV/ART status and adjusted prevalence ratios (aPRs) calculated using log-binomial regression. Results: Overall 171,960 pregnant people and their singleton newborns were included, 19% (N = 32,015) identified with HIV. Amongst pregnant people with HIV (PPHIV), 60% (N = 19,157) were on ART preconception, 29% (N = 9,276) initiated ART during pregnancy and 11% (N = 3,582) had no ART. Adjusted for maternal age, multiparity, hypertensive disorders and residential district, stillbirths were higher only for PPHIV not on ART (aPR 1.31 [95%CI 1.04–1.66]) compared to those without HIV. However, LBW and VLBW were higher among all PPHIV, with aPRs of 1.11–1.22 for LBW and 1.14–1.54 for VLBW. Pregnancy-initiated ART was associated with early pregnancy-related death (aPR 3.21; 95%CI 1.55–6.65), and HIV with or without ART was associated with late pregnancy-related death (aPRs 7.89–9.01). Conclusions: Even in the universal ART era, PPHIV experienced higher rates of LBW and VLBW newborns, and higher late pregnancy-related death regardless of ART status than pregnant people without HIV.
    Type of Medium: Online Resource
    ISSN: 0269-9370 , 1473-5571
    URL: Article
    DOI: 10.1097/QAD.0000000000003728
    RVK:
    XA 16838
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2023
    detail.hit.zdb_id: 2012212-3
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  • 6
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    A Prospective Cohort Study of Common Childhood Infections in South African HIV-exposed Uninfected and HIV-unexposed Infants
    Ovid Technologies (Wolters Kluwer Health) ; 2017
    In:  Pediatric Infectious Disease Journal Vol. 36, No. 2 ( 2017-02), p. e38-e44
    Details
    In: Pediatric Infectious Disease Journal, Ovid Technologies (Wolters Kluwer Health), Vol. 36, No. 2 ( 2017-02), p. e38-e44
    Type of Medium: Online Resource
    ISSN: 0891-3668
    URL: Article
    DOI: 10.1097/INF.0000000000001391
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2017
    detail.hit.zdb_id: 2020216-7
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  • 7
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    Online Resource
    Lower birth weight-for-age and length-for-age z-scores in infants with in-utero HIV and ART exposure: a prospective study in Cape Town, South Africa
    Springer Science and Business Media LLC ; 2021
    In:  BMC Pregnancy and Childbirth Vol. 21, No. 1 ( 2021-12)
    Details
    In: BMC Pregnancy and Childbirth, Springer Science and Business Media LLC, Vol. 21, No. 1 ( 2021-12)
    Abstract: Successful scale-up of antiretroviral therapy (ART) during pregnancy has minimized infant HIV acquisition, and over 1 million infants are born HIV-exposed but uninfected (HEU), with an increasing proportion also exposed in utero to maternal ART. While benefits of ART in pregnancy outweigh risks, some studies have reported associations between in utero ART exposure and impaired fetal growth, highlighting the need to identify the safest ART regimens for use in pregnancy. Methods We compared birth anthropometrics of infants who were HEU with those HIV-unexposed (HU) in Cape Town, South Africa. Pregnant women had gestational age assessed by ultrasound at enrolment. Women living with HIV were on ART (predominately tenofovir-emtricitabine-efavirenz) either prior to conception or initiated during pregnancy. Birth weights and lengths were converted to weight-for-age (WAZ) and length-for-age (LAZ) z-scores using Intergrowth-21st software. Linear regression was used to compare mean z-scores adjusting for maternal and pregnancy characteristics. Results Among 888 infants, 49% ( n  = 431) were HEU and 51% ( n  = 457) HU. Of 431 HEU infants, 62% ( n  = 268) were exposed to HIV and antiretrovirals (ARVs) from conception and 38% ( n  = 163) were exposed to ARVs during gestation but after conception (median fetal ARV exposure of 21 weeks [IQR; 17–26]). In univariable analysis, infants who were HEU had lower mean WAZ compared with HU [β = − 0.15 (95% Confidence Interval (CI): − 0.28, − 0.020)] . After adjustment for maternal age, gravidity, alcohol use, marital and employment status the effect remained [adjusted β − 0.14 (95%CI: − 0.28, − 0.01]. Similar differences were noted for mean LAZ in univariable [β − 0.20 (95%CI: − 0.42, − 0.01] but not multivariable analyses [adjusted β − 0.18 (95%CI: − 0.41, + 0.04] after adjusting for the same variables. Mean WAZ and LAZ did not vary by in utero ARV exposure duration among infants who were HEU. Conclusion In a cohort with high prevalence of ART exposure in pregnancy, infants who were HEU had lower birth WAZ compared with those HU. Studies designed to identify the mechanisms and clinical significance of these disparities, and to establish the safest ART for use in pregnancy are urgently needed.
    Type of Medium: Online Resource
    ISSN: 1471-2393
    URL: Article
    DOI: 10.1186/s12884-021-03836-z
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2021
    detail.hit.zdb_id: 2059869-5
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  • 8
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    Neurodevelopmental outcome of HIV‐exposed but uninfected infants in the Mother and Infants Health Study, Cape Town, South Africa
    Wiley ; 2018
    In:  Tropical Medicine & International Health Vol. 23, No. 1 ( 2018-01), p. 69-78
    Details
    In: Tropical Medicine & International Health, Wiley, Vol. 23, No. 1 ( 2018-01), p. 69-78
    Abstract: Comparer les résultats neuro‐développementaux des nourrissons exposés non infectés ( ENI ) et non exposés non infectés ( NENI ) par le VIH dans une population sud‐africaine périurbaine. Les nourrissons ENI vivant en Afrique font face à des risques biologiques et environnementaux uniques, mais l'incertitude demeure quant à leurs résultats neuro‐développementaux. Cela est dû en partie au manque de groupes de comparaison NENI bien appariés, nécessaires pour ajuster pour les facteurs de confusion. Méthodes Etude de cohorte prospective sur des nourrissons inscrits à la naissance dans une institution obstétricale à sages‐femmes de faible risque. A l’âge de 12 mois, la croissance et les résultats neuro‐développementaux des nourrissons ENI et NENI ont été comparés. La croissance a été évaluée selon les scores de l’ OMS du poids selon l’âge, de la taille selon l’âge, du poids pour la taille et de la circonférence crânienne pour l’âge. Les résultats neuro‐développementaux ont été évalués en utilisant les échelles de Bayley du développement du nourrisson III ( BSID ) et Alarm Distress Baby Scale ( ADBB ). Résultats 58 nourrissons ENI et 38 NENI ont été évalués entre 11 et 14 mois. Les performances sur l’échelle BSID ne différaient dans aucun des domaines entre nourrissons ENI et NENI . Les scores cognitifs, linguistiques et moteurs étaient dans la fourchette moyenne (normes standards américaines). Sept (12%) nourrissons ENI et 1 (2,6%) NENI ont montré un retrait social sur l’échelle ADBB (p = 0,10), tandis que 15 (26%) ENI et 4 (11%) NENI ont montré une diminution de la vocalisation (p = 0,06). Il n'y avait pas de différences de croissance. Trois nourrissons ENI et 1 NENI avaient des signes neurologiques mineurs, alors que 8 nourrissons ENI et 2 NENI avaient une macrocéphalie. Conclusions Bien que les résultats sur le développement neurologique précoce des nourrissons ENI soient rassurants, des différences mineures dans la vocalisation et l'examen neurologique indiquent un besoin de réévaluation à un âge plus avancé.
    Type of Medium: Online Resource
    ISSN: 1360-2276 , 1365-3156
    URL: Issue
    URL: Article
    DOI: 10.1111/tmi.2018.23.issue-1
    DOI: 10.1111/tmi.13006
    Language: English
    Publisher: Wiley
    Publication Date: 2018
    detail.hit.zdb_id: 2018112-7
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  • 9
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    Methodological Considerations in Evaluating Pregnancy Outcomes in Women Living With HIV
    Ovid Technologies (Wolters Kluwer Health) ; 2019
    In:  JAIDS Journal of Acquired Immune Deficiency Syndromes Vol. 81, No. 2 ( 2019-06-1), p. e63-e64
    Details
    In: JAIDS Journal of Acquired Immune Deficiency Syndromes, Ovid Technologies (Wolters Kluwer Health), Vol. 81, No. 2 ( 2019-06-1), p. e63-e64
    Type of Medium: Online Resource
    ISSN: 1525-4135
    URL: Article
    DOI: 10.1097/QAI.0000000000002014
    RVK:
    XA 10000
    RVK:
    XA 51942
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2019
    detail.hit.zdb_id: 2038673-4
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  • 10
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    Online Resource
    Investment Long Overdue in Primary Studies of HIV-exposed Uninfected Infant Infectious Morbidity
    Ovid Technologies (Wolters Kluwer Health) ; 2019
    In:  Pediatric Infectious Disease Journal Vol. 38, No. 7 ( 2019-07), p. e164-e165
    Details
    In: Pediatric Infectious Disease Journal, Ovid Technologies (Wolters Kluwer Health), Vol. 38, No. 7 ( 2019-07), p. e164-e165
    Type of Medium: Online Resource
    ISSN: 0891-3668
    URL: Article
    DOI: 10.1097/INF.0000000000002249
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2019
    detail.hit.zdb_id: 2020216-7
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