Nutrition, morbidity and mortality status in a cohort of children (0-14 years) exposed to maternal HIV in south India

Abstract

Abstract Background: India has a substantial HIV disease burden in children. Karnataka state in south India has prevalence higher than the national average. About 6.3% of all people living with HIV (PLHIV) are children. Methods: The present study is a prospective community-based open cohort study among children aged 0-14 years, exposed to maternal HIV in Belgaum district of Karnataka between the years 2014-2018. The study compares the nutrition (age 0-59 months) and morbidity patterns in HIV infected and non-infected children, while also estimating the risk of death and survival estimates in these cases during the follow-up period. Data was analysed using changes in Z scores for the indices, linear regression analysis; univariate and multivariate logistic regression analysis for differences in the prevalence of morbidity between HIV-positive and HIV-negative children. Cox proportional hazard model was used to estimate the risk of death. Results: Study results demonstrate that the nutrition status of HIV positive children deteriorated more severely than that among HIV negative children as is evident from statistically significant difference (p value 0.045 and 0.028) in Z scores for anthropometric indices of weight for height and weight for age. HIV positive and HIV negative children indicate that HIV positive children had 3.27 (95% CI: 2.35-4.56) and 2.86 (95% CI:1.83, 4.45) times higher risk of having skin diseases. Mortality analysis indicated that the hazard of dying during the follow-up period is almost five times higher for HIV positive children than the HIV negative children. Conclusions: The study highlights the importance of scaling up diagnosis, and treatment for children within families with an index person living with HIV to increase improve the provision of nutrition and social support to both HIV positive and negative children at a family level. In particular, the impact of tuberculosis (TB) among children living with HIV needs focused priority and attention. These measures can reduce the high rates of under-nutrition, mortality and morbidity and improve the overall survival of children impacted by HIV.