Maternal and infant factors associated with failure to thrive in children with vertically transmitted human immunodeficiency virus-1 infection: The prospective, P 2C 2 human immunodeficiency virus multicenter study

Tracie L Miller, Kirk A. Easley, Weihong Zhang, E. John Orav, Dennis M. Bier, Elisabeth Luder, Andrew Ting, William T. Shearer, Jorge Humberto Vargas, Steven E Lipshultz

Research output: Contribution to journalArticle

43 Citations (Scopus)

Abstract

Objective. Many children with human immunodeficiency virus-1 (HIV-1) have chronic problems with growth and nutrition, yet limited information is available to identify infected children at high risk for growth abnormalities. Using data from the prospective, multicenter P 2C 2 HIV study, we evaluated the relationships between maternal and infant clinical and laboratory factors and impaired growth in this cohort. Methods. Children of HIV-1-infected women were enrolled prenatally or within the first 28 days of life. Failure to thrive (FTT) was defined as an age- and sex-adjusted weight z score ≤-2.0 SD. Maternal baseline covariates included age, race, illicit drug use, zidovudine use, CD4 + T-cell count, and smoking. Infant baseline predictors included sex, race, CD4 + T-cell count, Centers for Disease Control stage, HIV-1 RNA, antiretroviral therapy, pneumonia, heart rate, cytomegalovirus and Epstein-Barr virus infection status. Results. The study cohort included 92 HIV-1-infected and 439 uninfected children. Infected children had a lower mean gestational age, but birth weights, lengths, and head circumferences in the 2 groups were similar. Mothers of growth-delayed infants were more likely to have smoked tobacco and used illicit drugs during pregnancy. In repeated-measures analyses of weight and length or height z scores, the means of the HIV-1-infected group were significantly 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 heroin 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 antiretroviral therapy by 3 months of age (RR = 2.77; 95% CI: 1.16-6.65). After adjustment for pneumonia and antiretroviral therapy, HIV-1 RNA load remained associated with FTT in the subset of children whose serum was available 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 antiretroviral therapy by 3 months of age (non-protease inhibitor), and HIV-1 RNA viral load.

Original languageEnglish
Pages (from-to)1287-1296
Number of pages10
JournalPediatrics
Volume108
Issue number6
DOIs
StatePublished - Dec 18 2001
Externally publishedYes

Fingerprint

Failure to Thrive
HIV-2
Virus Diseases
Multicenter Studies
HIV-1
Mothers
CD4 Lymphocyte Count
Pneumonia
Street Drugs
Confidence Intervals
T-Lymphocytes
RNA
Viral Load
Pregnancy
Growth
Crack Cocaine
Weights and Measures
Epstein-Barr Virus Infections
Zidovudine
Heroin

Keywords

  • Children
  • Failure to thrive
  • Growth
  • Human immunodeficiency virus
  • Malnutrition

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Maternal and infant factors associated with failure to thrive in children with vertically transmitted human immunodeficiency virus-1 infection : The prospective, P 2C 2 human immunodeficiency virus multicenter study. / Miller, Tracie L; Easley, Kirk A.; Zhang, Weihong; Orav, E. John; Bier, Dennis M.; Luder, Elisabeth; Ting, Andrew; Shearer, William T.; Vargas, Jorge Humberto; Lipshultz, Steven E.

In: Pediatrics, Vol. 108, No. 6, 18.12.2001, p. 1287-1296.

Research output: Contribution to journalArticle

Miller, Tracie L ; Easley, Kirk A. ; Zhang, Weihong ; Orav, E. John ; Bier, Dennis M. ; Luder, Elisabeth ; Ting, Andrew ; Shearer, William T. ; Vargas, Jorge Humberto ; Lipshultz, Steven E. / Maternal and infant factors associated with failure to thrive in children with vertically transmitted human immunodeficiency virus-1 infection : The prospective, P 2C 2 human immunodeficiency virus multicenter study. In: Pediatrics. 2001 ; Vol. 108, No. 6. pp. 1287-1296.
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abstract = "Objective. Many children with human immunodeficiency virus-1 (HIV-1) have chronic problems with growth and nutrition, yet limited information is available to identify infected children at high risk for growth abnormalities. Using data from the prospective, multicenter P 2C 2 HIV study, we evaluated the relationships between maternal and infant clinical and laboratory factors and impaired growth in this cohort. Methods. Children of HIV-1-infected women were enrolled prenatally or within the first 28 days of life. Failure to thrive (FTT) was defined as an age- and sex-adjusted weight z score ≤-2.0 SD. Maternal baseline covariates included age, race, illicit drug use, zidovudine use, CD4 + T-cell count, and smoking. Infant baseline predictors included sex, race, CD4 + T-cell count, Centers for Disease Control stage, HIV-1 RNA, antiretroviral therapy, pneumonia, heart rate, cytomegalovirus and Epstein-Barr virus infection status. Results. The study cohort included 92 HIV-1-infected and 439 uninfected children. Infected children had a lower mean gestational age, but birth weights, lengths, and head circumferences in the 2 groups were similar. Mothers of growth-delayed infants were more likely to have smoked tobacco and used illicit drugs during pregnancy. In repeated-measures analyses of weight and length or height z scores, the means of the HIV-1-infected group were significantly 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 heroin 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 antiretroviral therapy by 3 months of age (RR = 2.77; 95{\%} CI: 1.16-6.65). After adjustment for pneumonia and antiretroviral therapy, HIV-1 RNA load remained associated with FTT in the subset of children whose serum was available 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 antiretroviral therapy by 3 months of age (non-protease inhibitor), and HIV-1 RNA viral load.",
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T1 - Maternal and infant factors associated with failure to thrive in children with vertically transmitted human immunodeficiency virus-1 infection

T2 - The prospective, P 2C 2 human immunodeficiency virus multicenter study

AU - Miller, Tracie L

AU - Easley, Kirk A.

AU - Zhang, Weihong

AU - Orav, E. John

AU - Bier, Dennis M.

AU - Luder, Elisabeth

AU - Ting, Andrew

AU - Shearer, William T.

AU - Vargas, Jorge Humberto

AU - Lipshultz, Steven E

PY - 2001/12/18

Y1 - 2001/12/18

N2 - Objective. Many children with human immunodeficiency virus-1 (HIV-1) have chronic problems with growth and nutrition, yet limited information is available to identify infected children at high risk for growth abnormalities. Using data from the prospective, multicenter P 2C 2 HIV study, we evaluated the relationships between maternal and infant clinical and laboratory factors and impaired growth in this cohort. Methods. Children of HIV-1-infected women were enrolled prenatally or within the first 28 days of life. Failure to thrive (FTT) was defined as an age- and sex-adjusted weight z score ≤-2.0 SD. Maternal baseline covariates included age, race, illicit drug use, zidovudine use, CD4 + T-cell count, and smoking. Infant baseline predictors included sex, race, CD4 + T-cell count, Centers for Disease Control stage, HIV-1 RNA, antiretroviral therapy, pneumonia, heart rate, cytomegalovirus and Epstein-Barr virus infection status. Results. The study cohort included 92 HIV-1-infected and 439 uninfected children. Infected children had a lower mean gestational age, but birth weights, lengths, and head circumferences in the 2 groups were similar. Mothers of growth-delayed infants were more likely to have smoked tobacco and used illicit drugs during pregnancy. In repeated-measures analyses of weight and length or height z scores, the means of the HIV-1-infected group were significantly 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 heroin 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 antiretroviral therapy by 3 months of age (RR = 2.77; 95% CI: 1.16-6.65). After adjustment for pneumonia and antiretroviral therapy, HIV-1 RNA load remained associated with FTT in the subset of children whose serum was available 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 antiretroviral therapy by 3 months of age (non-protease inhibitor), and HIV-1 RNA viral load.

AB - Objective. Many children with human immunodeficiency virus-1 (HIV-1) have chronic problems with growth and nutrition, yet limited information is available to identify infected children at high risk for growth abnormalities. Using data from the prospective, multicenter P 2C 2 HIV study, we evaluated the relationships between maternal and infant clinical and laboratory factors and impaired growth in this cohort. Methods. Children of HIV-1-infected women were enrolled prenatally or within the first 28 days of life. Failure to thrive (FTT) was defined as an age- and sex-adjusted weight z score ≤-2.0 SD. Maternal baseline covariates included age, race, illicit drug use, zidovudine use, CD4 + T-cell count, and smoking. Infant baseline predictors included sex, race, CD4 + T-cell count, Centers for Disease Control stage, HIV-1 RNA, antiretroviral therapy, pneumonia, heart rate, cytomegalovirus and Epstein-Barr virus infection status. Results. The study cohort included 92 HIV-1-infected and 439 uninfected children. Infected children had a lower mean gestational age, but birth weights, lengths, and head circumferences in the 2 groups were similar. Mothers of growth-delayed infants were more likely to have smoked tobacco and used illicit drugs during pregnancy. In repeated-measures analyses of weight and length or height z scores, the means of the HIV-1-infected group were significantly 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 heroin 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 antiretroviral therapy by 3 months of age (RR = 2.77; 95% CI: 1.16-6.65). After adjustment for pneumonia and antiretroviral therapy, HIV-1 RNA load remained associated with FTT in the subset of children whose serum was available 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 antiretroviral therapy by 3 months of age (non-protease inhibitor), and HIV-1 RNA viral load.

KW - Children

KW - Failure to thrive

KW - Growth

KW - Human immunodeficiency virus

KW - Malnutrition

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