Morbidity changes between HIV unexposed uninfected and HIV exposed uninfected children in Harare –a secondary data analysis

Abstract

Background: Optimising the survival of HIV exposed uninfected (HEU) infants is a major challenge. There is a significant swift increase in the HEU population due to the introduction of the highly active antiretroviral therapy (HAART). Infections may be more severe in the HEU children as compared to their HIV unexposed uninfected (HUU) counterparts. Longitudinal studies give an understanding of the morbidity patterns in HEU children and possible factors associated with the observed morbidity differences between HEU and HUU can be explained through a longitudinal model. Broadly, this study aims to assess morbidity trends and factors associated with change in morbidity between HEU and HUU children in a nine months follow-up period. Materials and Methods: A cohort of index babies was followed up from delivery for nine months. The maternal HIV status during pregnancy set as the exposure status for this cohort. Morbidity outcomes, illnesses and admissions, were observed within the follow-up period between the HEU and HUU children. HIV exposed infected (HEI) index babies were excluded from the analysis. The follow-up time points were at six weeks, four months and nine months. Mixed effects logistic regression analysis was used to determine factors associated with change in morbidity between the HEU and HUU. Results: The average child-specific intercept for the log odds of morbidity was 1.04. There was a 1.12 heterogeneity difference at baseline. A negative exposure change of 0.06 in the first sixteen weeks and a positive exposure change of 0.04 after sixteen weeks were observed. Being HEU had a protective effect with an odds ratio of 0.77 and a confidence interval of (0.38; 1.26) which is not statistically significant. . Conclusion: Being exposed to HIV is protective with an odds ratio of 0.77 (0.38; 1.26). There is a significance difference in the heterogeneity of the groups at baseline. The unexposed group has a significant negative trend during the first sixteen weeks and a positive trend after sixteen weeks. The exposed group has a less negative and positive trend across time. The family size has a protective effect towards morbidity in children.