Maternal Antiretroviral Therapy Is Associated with Lower Risk of Diarrhea in Early Childhood
Identifieur interne : 003809 ( Ncbi/Merge ); précédent : 003808; suivant : 003810Maternal Antiretroviral Therapy Is Associated with Lower Risk of Diarrhea in Early Childhood
Auteurs : Kevin A. Sztam [États-Unis] ; Enju Liu [États-Unis] ; Karim P. Manji [Tanzanie] ; Roland Kupka [États-Unis] ; Rodrick Kisenge [Tanzanie] ; Said Aboud [Tanzanie] ; Wafaie W. Fawzi [États-Unis] ; Ronald J. Bosch [États-Unis] ; Christopher P. Duggan [États-Unis]Source :
- The Journal of pediatrics [ 0022-3476 ] ; 2016.
Abstract
To identify risk factors, including maternal antiretroviral therapy (ART), for diarrhea in Tanzanian children exposed to HIV during the first 2 years of life.
Using generalized estimating equations, we analyzed data from a cohort of 2387 Tanzanian children exposed to HIV from age 6 weeks to 2 years, as well as data from their mothers, to determine risk factors for diarrhea in children. Mothers recorded diarrhea in a diary and reported results at visits scheduled every four weeks.
Body mass index was ≥18.5 in 95.6% of mothers. World Health Organization HIV stage was 1/2 for 1255 (87.8%) mothers. ART was received by 24.3% of mothers, most initiating ART during pregnancy. At baseline (6 weeks of age) 264 (11.3%) children were infected with HIV. In children whose mothers received ART, the relative risk of diarrhea in children was 0.79 (95% CI 0.68–0.92), after we adjusted for multiple factors, including child HIV status and exclusive breastfeeding duration. Exclusive breastfeeding (relative risk 0.67, 95% CI 0.56–0.80) also was protective.
Our results provide additional support to increase ART coverage for all pregnant mothers, to control clinical HIV progression, reduce perinatal HIV infection, but also to reduce the risk of a major cause of death and morbidity in young children worldwide.
ClinicalTrials.gov: NCT00197730.
Url:
DOI: 10.1016/j.jpeds.2016.04.088
PubMed: 27245295
PubMed Central: 4981520
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<front><div type="abstract" xml:lang="en"><sec id="S1"><title>Objectives</title>
<p id="P1">To identify risk factors, including maternal antiretroviral therapy (ART), for diarrhea in Tanzanian children exposed to HIV during the first 2 years of life.</p>
</sec>
<sec id="S2"><title>Study design</title>
<p id="P2">Using generalized estimating equations, we analyzed data from a cohort of 2387 Tanzanian children exposed to HIV from age 6 weeks to 2 years, as well as data from their mothers, to determine risk factors for diarrhea in children. Mothers recorded diarrhea in a diary and reported results at visits scheduled every four weeks.</p>
</sec>
<sec id="S3"><title>Results</title>
<p id="P3">Body mass index was ≥18.5 in 95.6% of mothers. World Health Organization HIV stage was 1/2 for 1255 (87.8%) mothers. ART was received by 24.3% of mothers, most initiating ART during pregnancy. At baseline (6 weeks of age) 264 (11.3%) children were infected with HIV. In children whose mothers received ART, the relative risk of diarrhea in children was 0.79 (95% CI 0.68–0.92), after we adjusted for multiple factors, including child HIV status and exclusive breastfeeding duration. Exclusive breastfeeding (relative risk 0.67, 95% CI 0.56–0.80) also was protective.</p>
</sec>
<sec id="S4"><title>Conclusion</title>
<p id="P4">Our results provide additional support to increase ART coverage for all pregnant mothers, to control clinical HIV progression, reduce perinatal HIV infection, but also to reduce the risk of a major cause of death and morbidity in young children worldwide.</p>
</sec>
<sec id="S5"><title>Trial registration</title>
<p id="P5">ClinicalTrials.gov: NCT00197730.</p>
</sec>
</div>
</front>
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<front><journal-meta><journal-id journal-id-type="nlm-journal-id">0375410</journal-id>
<journal-id journal-id-type="pubmed-jr-id">5127</journal-id>
<journal-id journal-id-type="nlm-ta">J Pediatr</journal-id>
<journal-id journal-id-type="iso-abbrev">J. Pediatr.</journal-id>
<journal-title-group><journal-title>The Journal of pediatrics</journal-title>
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<article-id pub-id-type="manuscript">NIHMS791181</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Article</subject>
</subj-group>
</article-categories>
<title-group><article-title>Maternal Antiretroviral Therapy Is Associated with Lower Risk of Diarrhea in Early Childhood</article-title>
</title-group>
<contrib-group><contrib contrib-type="author"><name><surname>Sztam</surname>
<given-names>Kevin A.</given-names>
</name>
<degrees>MD, MPH</degrees>
<xref ref-type="aff" rid="A1">1</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Liu</surname>
<given-names>Enju</given-names>
</name>
<degrees>MD, MS, PhD</degrees>
<xref ref-type="aff" rid="A1">1</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Manji</surname>
<given-names>Karim P.</given-names>
</name>
<degrees>MBBS, MPH</degrees>
<xref ref-type="aff" rid="A2">2</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Kupka</surname>
<given-names>Roland</given-names>
</name>
<degrees>ScD</degrees>
<xref ref-type="aff" rid="A3">3</xref>
<xref ref-type="aff" rid="A4">4</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Kisenge</surname>
<given-names>Rodrick</given-names>
</name>
<degrees>MD, PhD</degrees>
<xref ref-type="aff" rid="A2">2</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Aboud</surname>
<given-names>Said</given-names>
</name>
<degrees>MD, MPhil</degrees>
<xref ref-type="aff" rid="A5">5</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Fawzi</surname>
<given-names>Wafaie W.</given-names>
</name>
<degrees>MBBS, DrPH</degrees>
<xref ref-type="aff" rid="A6">6</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Bosch</surname>
<given-names>Ronald J.</given-names>
</name>
<degrees>PhD</degrees>
<xref ref-type="aff" rid="A7">7</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Duggan</surname>
<given-names>Christopher P.</given-names>
</name>
<degrees>MD, MPH</degrees>
<xref ref-type="aff" rid="A1">1</xref>
<xref ref-type="aff" rid="A3">3</xref>
</contrib>
</contrib-group>
<aff id="A1"><label>1</label>
Division of Gastroenterology, Hepatology and Nutrition, Boston Children’s Hospital, Boston, MA</aff>
<aff id="A2"><label>2</label>
Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania</aff>
<aff id="A3"><label>3</label>
Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA</aff>
<aff id="A4"><label>4</label>
Nutrition Section, UNICEF Headquarters, New York, NY</aff>
<aff id="A5"><label>5</label>
Department of Microbiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania</aff>
<aff id="A6"><label>6</label>
Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA</aff>
<aff id="A7"><label>7</label>
Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA</aff>
<author-notes><corresp id="FN1">Reprint requests: Kevin A. Sztam, MD, MPH, Division of Gastroenterology, Hepatology and Nutrition, Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA 02115. <email>Kevin.Sztam@childrens.harvard.edu</email>
</corresp>
</author-notes>
<pub-date pub-type="nihms-submitted"><day>10</day>
<month>6</month>
<year>2016</year>
</pub-date>
<pub-date pub-type="epub"><day>28</day>
<month>5</month>
<year>2016</year>
</pub-date>
<pub-date pub-type="ppub"><month>8</month>
<year>2016</year>
</pub-date>
<pub-date pub-type="pmc-release"><day>01</day>
<month>8</month>
<year>2017</year>
</pub-date>
<volume>175</volume>
<fpage>54</fpage>
<lpage>60</lpage>
<pmc-comment>elocation-id from pubmed: 10.1016/j.jpeds.2016.04.088</pmc-comment>
<abstract><sec id="S1"><title>Objectives</title>
<p id="P1">To identify risk factors, including maternal antiretroviral therapy (ART), for diarrhea in Tanzanian children exposed to HIV during the first 2 years of life.</p>
</sec>
<sec id="S2"><title>Study design</title>
<p id="P2">Using generalized estimating equations, we analyzed data from a cohort of 2387 Tanzanian children exposed to HIV from age 6 weeks to 2 years, as well as data from their mothers, to determine risk factors for diarrhea in children. Mothers recorded diarrhea in a diary and reported results at visits scheduled every four weeks.</p>
</sec>
<sec id="S3"><title>Results</title>
<p id="P3">Body mass index was ≥18.5 in 95.6% of mothers. World Health Organization HIV stage was 1/2 for 1255 (87.8%) mothers. ART was received by 24.3% of mothers, most initiating ART during pregnancy. At baseline (6 weeks of age) 264 (11.3%) children were infected with HIV. In children whose mothers received ART, the relative risk of diarrhea in children was 0.79 (95% CI 0.68–0.92), after we adjusted for multiple factors, including child HIV status and exclusive breastfeeding duration. Exclusive breastfeeding (relative risk 0.67, 95% CI 0.56–0.80) also was protective.</p>
</sec>
<sec id="S4"><title>Conclusion</title>
<p id="P4">Our results provide additional support to increase ART coverage for all pregnant mothers, to control clinical HIV progression, reduce perinatal HIV infection, but also to reduce the risk of a major cause of death and morbidity in young children worldwide.</p>
</sec>
<sec id="S5"><title>Trial registration</title>
<p id="P5">ClinicalTrials.gov: NCT00197730.</p>
</sec>
</abstract>
</article-meta>
</front>
</pmc>
<affiliations><list><country><li>Tanzanie</li>
<li>États-Unis</li>
</country>
<region><li>Massachusetts</li>
<li>État de New York</li>
</region>
</list>
<tree><country name="États-Unis"><region name="Massachusetts"><name sortKey="Sztam, Kevin A" sort="Sztam, Kevin A" uniqKey="Sztam K" first="Kevin A." last="Sztam">Kevin A. Sztam</name>
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<name sortKey="Bosch, Ronald J" sort="Bosch, Ronald J" uniqKey="Bosch R" first="Ronald J." last="Bosch">Ronald J. Bosch</name>
<name sortKey="Duggan, Christopher P" sort="Duggan, Christopher P" uniqKey="Duggan C" first="Christopher P." last="Duggan">Christopher P. Duggan</name>
<name sortKey="Duggan, Christopher P" sort="Duggan, Christopher P" uniqKey="Duggan C" first="Christopher P." last="Duggan">Christopher P. Duggan</name>
<name sortKey="Fawzi, Wafaie W" sort="Fawzi, Wafaie W" uniqKey="Fawzi W" first="Wafaie W." last="Fawzi">Wafaie W. Fawzi</name>
<name sortKey="Kupka, Roland" sort="Kupka, Roland" uniqKey="Kupka R" first="Roland" last="Kupka">Roland Kupka</name>
<name sortKey="Kupka, Roland" sort="Kupka, Roland" uniqKey="Kupka R" first="Roland" last="Kupka">Roland Kupka</name>
<name sortKey="Liu, Enju" sort="Liu, Enju" uniqKey="Liu E" first="Enju" last="Liu">Enju Liu</name>
</country>
<country name="Tanzanie"><noRegion><name sortKey="Manji, Karim P" sort="Manji, Karim P" uniqKey="Manji K" first="Karim P." last="Manji">Karim P. Manji</name>
</noRegion>
<name sortKey="Aboud, Said" sort="Aboud, Said" uniqKey="Aboud S" first="Said" last="Aboud">Said Aboud</name>
<name sortKey="Kisenge, Rodrick" sort="Kisenge, Rodrick" uniqKey="Kisenge R" first="Rodrick" last="Kisenge">Rodrick Kisenge</name>
</country>
</tree>
</affiliations>
</record>
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