Early Onset Overweight, Stunting Seen in Children Exposed to HIV and ART

breast feeding
A study shows that there are small but consistent deficits in the early growth trajectories of young children who were breastfed and exposed to HIV.

Data from a peri-urban community in South Africa showed that there are small but consistent deficits in the early growth trajectories of young children who were breastfed and exposed to HIV but uninfected (HEU) compared with children who were not exposed to HIV (HU). Findings from the study were published in the Lancet Child & Adolescent Health.1

Few data exist on the growth of HEU children since a shift toward universal antiretroviral therapy (ART) for pregnant and breastfeeding women as standard of care in sub-Saharan Africa.2,3 As such, researchers conducted a prospective, cohort study comprised of 872 mother-child pairs. Data from 2 studies were used: all women with HIV were participants of the Maternal Child Health Antiretroviral Therapy study (MCH-ART; ClinicalTrials.gov identifier: NCT01933477) and all women who did not have HIV were part of the HIV-unexposed-uninfected (HU2) cohort study. Run in parallel with MCH-ART with the same study staff, facilities, and procedures, HU2 was specifically designed to complement MCH-ART by providing a community-control comparison group.

All women were followed from their first antenatal clinic visit through pregnancy to delivery, and with their breastfed children until 12 months postpartum. Child anthropometry was measured at around 6 weeks and every 3 months from month 3 to month 12. Age-adjusted, sex-adjusted, and gestation-adjusted Z-scores were generated for weight-for-age, length-for-age, weight-for-length, head circumference-for-age, and body mass index-for-age and compared between HEU and HU children.

Between June 2013 and April 2016, 461 HEU and 411 HU children attended 4511 study visits in total, with a median of 6 visits per child. Birth characteristics were similar between the groups, but median duration of breastfeeding was shorter in the HEU compared with the HU children (3.9 vs 9 months; P =.0001).

Although weight-for-age scores gradually increased in both groups after 6 weeks, HEU children had consistently lower scores than HU children throughout follow-up (crude overall β –0.34; 95% CI, –0.47 to –0.21). Results remained similar in adjusted analyses.

Length-for-age scores decreased in both groups after 9 months. By 12 months, HEU children had significantly lower mean length-for-age scores than HU children (-0.51 [standard deviation 1.27] vs -0.02 [standard deviation 1.13]; β -0.43; 95% CI, -0.61 to -0.25). Moreover, HEU children were twice as likely to be stunted (length-for-age score ≤2) compared with HU children (10% [35 of 342] vs 4% [14 of 342]; odd ratio [OR] 2.67; 95% CI, 1.41-5.06). Results were similar after adjusting for confounders including small-for-gestational age and preterm birth.

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By 12 months, a large proportion of both HEU and HU children were overweight (weight-for-length score >2: 16% vs 18%; OR 0.87; 95% CI, 0.58-1.31). Findings were similar in analyses using body mass index instead of weight-for-length to compare proportional size between HEU and HU children in both crude and adjusted linear and logistic regression models.

Although “the long-term effects of early onset overweight and stunting in children exposed to HIV and ART require further investigation, addressing childhood obesity should be an urgent public health priority in this setting,” concluded the researchers.


  1. le Roux SM, Abrams EJ, Donald KA, et al. Growth trajectories of breastfed HIV-exposed uninfected and HIV-unexposed children under conditions of universal maternal antiretroviral therapy: a prospective study. Lancet Child Adolesc Health. 2019;3:234-244.
  2. World Health Organization. Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection: recommendations for a public health approach – second edition. https://www.who.int/hiv/pub/arv/arv-2016/en/. June 2016. Accessed April 1, 2019.
  3. WHO, United Nations Children’s Fund. Guideline: updates on HIV and infant feeding: the duration of breastfeeding, and support from health services to improve feeding practices among mothers living with HIV. https://apps.who.int/iris/bitstream/handle/10665/246260/9789241549707-eng.pdf;jsessionid=17022391262FB0828834A4654FC18FAF?sequence=1. 2016. Accessed March 14, 2019.