In-utero HIV exposure and cardiometabolic health among children 5-8 years: findings from a prospective birth cohort in South Africa

Objective: To evaluate if in-utero HIV exposure is associated with adverse cardiometabolic health outcomes at 5-8 years of age. Design: Prospective cohort study. Methods: We enrolled a random sample of HIV-exposed but uninfected (HEU) and HIV-unexposed children from the Drakenstein Child Health study, a longitudinal birth cohort study in Cape Town, South Africa, in a cardiometabolic health pilot study. Outcomes were assessed by trained study staff and included: anthropometry, body composition and size, blood pressure, fasting plasma glucose, HbA1c, lipids, and insulin resistance using HOMA-IR. We used multivariable linear and log-binomial regression to estimate associations between HIV-exposure and cardiometabolic outcomes, adjusted for child age, sex, height, body size, and maternal factors as appropriate. Results: We included 260 children (HEU n=100, HIV-unexposed n=160). HEU children had older mothers (median age 30 vs. 26 years), with minimal differences in gestational age and size at birth by HIV-exposure status. In multivariable analyses, HEU children had lower weight-for-age (mean difference -0.35, 95% confidence interval -0.66, -0.05), and height-for-age (mean difference -0.29, 95% confidence interval -0.56, -0.03; z-scores). There were no differences in adiposity, impaired glucose metabolism, or lipid levels by HIV-exposure status. Overall, 12% of children had blood pressure more than 90th percentile, with no differences by HIV-exposure status. Conclusion: Overall, there were few differences in cardiometabolic outcomes between HEU and HIV-unexposed children in this South African cohort. Although these findings are reassuring, monitoring of cardiometabolic health is important as HEU and HIV-unexposed children enter adolescence and cardiometabolic risk trajectories become established. Copyright (c) 2022 The Author(s). Published by Wolters Kluwer Health, Inc.

Automated summary

This prospective cohort study aimed to assess whether in-utero HIV exposure is associated with adverse cardiometabolic health outcomes among children aged 5-8. The study included HIV-exposed but uninfected (HEU) and HIV-unexposed children from a South African birth cohort. The results showed minimal differences in growth and metabolic outcomes between HEU and HIV-unexposed children, suggesting overall reassuring findings. However, continued monitoring of cardiometabolic health is important as these children enter adolescence and establish long-term risk trajectories.