HIV-Exposed Uninfected Children
Introduction
While studies have demonstrated increased risk of morbidity and mortality among HIV-Exposed Uninfected children (cHEU) in early life, the modalities of specialized follow-up once their HIV status has been confirmed negative is not clear.
Objective
The primary objective of this study was to determine the long-term risk of hospitalization, and incidence of chronic disease, among cHEU compared to HIV unexposed uninfected (cHUU) controls.
Methods
Longitudinal cohort study linking data from the Centre maternel et infantile sur le SIDA (CMIS) cohort to administrative data from the Régie de l’Assurance Maladie du Quebec (RAMQ), a universal health system with unique single patient identifiers, covering all care services provided. ICD-9 codes were extracted and grouped by system for measures of chronic diseases, cHEU children were matched 3:1 by age, gender and postal code to cHUU controls. Survival analysis was used to determine hospitalization risk over time, and the incidence of chronic disease compared between groups.
Key Results
(Excerpt from Long-term-canadian-study-shows-hiv-exposed-children-have-worse-health-outcomes, Mercy Shibemba, aidsmap, 25 August 2022)
Analysis of the datasets was carried out to look for indicators of poorer health outcomes, starting with hospital admissions. Over their life span, in this cohort the children of mothers living with HIV were 42% more likely to experience hospitalisation, which remained higher when adjusting for premature birth with a 23% difference.
Outcomes relating to six other categories were tracked.
Neurodevelopmental and psychiatric: Data were collected on a range of conditions, including psychoses, autism, delays in development, co-ordination disorders and intellectual disabilities. All of these saw a statistically significant increased risk for children of mothers living with HIV. Overall, they are 28% more likely to experience neurodevelopmental and psychiatric conditions.
A key disparity was intellectual disabilities. However, the overall occurrence was rare: 0.8% of children of mothers living with HIV experienced this, in comparison with 0.2% of children who were not exposed to HIV.
Delays in development occurred more than anything else, in around 12% of children of mothers living with HIV and 8.8% of children who were not exposed to HIV.
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Psychoses were experienced by 4.4% of children of mothers living with HIV. In comparison, 2.1% of children not exposed to HIV experienced psychoses.
Birth defects: Children of mothers living with HIV experienced atrial septal defects at a rate of 8.4%, in comparison to just 2.8% of children not exposed to HIV.
Results for congenital musculoskeletal anomalies were more elevated for both groups: children of mothers living with HIV at 15% and children not exposed to HIV at 11%.
Cardiovascular system: No significant differences were found in the risk of long-term cardiovascular conditions.
Cancer: No significant differences were found in the risk of cancer.
Growth and endocrine disorders: Children of mothers living with HIV were less likely to experience being underweight, being short or have feeding difficulties (around 10%) in comparison with 19% of the children not exposed to HIV. However, diabetes was more prevalent in the group of children of mothers living with HIV, at 13% vs 9% of children not exposed to HIV.
Respiratory: No significant differences were found on the risk of long-term respiratory conditions.
Outcomes relating to six other categories were tracked.
Neurodevelopmental and psychiatric: Data were collected on a range of conditions, including psychoses, autism, delays in development, co-ordination disorders and intellectual disabilities. All of these saw a statistically significant increased risk for children of mothers living with HIV. Overall, they are 28% more likely to experience neurodevelopmental and psychiatric conditions.
A key disparity was intellectual disabilities. However, the overall occurrence was rare: 0.8% of children of mothers living with HIV experienced this, in comparison with 0.2% of children who were not exposed to HIV.
Delays in development occurred more than anything else, in around 12% of children of mothers living with HIV and 8.8% of children who were not exposed to HIV.
More news from AIDS 2022
Psychoses were experienced by 4.4% of children of mothers living with HIV. In comparison, 2.1% of children not exposed to HIV experienced psychoses.
Birth defects: Children of mothers living with HIV experienced atrial septal defects at a rate of 8.4%, in comparison to just 2.8% of children not exposed to HIV.
Results for congenital musculoskeletal anomalies were more elevated for both groups: children of mothers living with HIV at 15% and children not exposed to HIV at 11%.
Cardiovascular system: No significant differences were found in the risk of long-term cardiovascular conditions.
Cancer: No significant differences were found in the risk of cancer.
Growth and endocrine disorders: Children of mothers living with HIV were less likely to experience being underweight, being short or have feeding difficulties (around 10%) in comparison with 19% of the children not exposed to HIV. However, diabetes was more prevalent in the group of children of mothers living with HIV, at 13% vs 9% of children not exposed to HIV.
Respiratory: No significant differences were found on the risk of long-term respiratory conditions.
Conclusions
In this resource-rich setting with universal health-care, cHEU had increased risk of hospitalization and neuro-psychiatric disorders, suggesting that cHEU would benefit from enhanced pediatric care, including early neurodevelopmental assessment.
References
- Shibemba, M. Long-term Canadian study shows HIV-exposed children have worse health outcomes. August 2022. aidsmap, 25 August 2022.
- Kakkar F. et al. Long-Term Risk of Hospitalization and Chronic Disease Among Children Who Were HIV Exposed and Uninfected (CHEU) Compared to Population Controls in Montreal, Canada. 14th International Workshop on HIV & Pediatrics, Montreal, July 2022. View this abstract on the conference website, p.17.
- Brochon J et al. Long-Term Risk of Hospitalization and Chronic Disease Among Children Who Were HIV Exposed and Uninfected (CHEU) Compared to Population Controls in Montreal, Canada. 24th International AIDS Conference, Montreal, abstract OAB0105, 2022. View this abstract on the conference website.