Studies from multiple countries have suggested impaired immunity in perinatally HIV-exposed uninfected (HEU) children, with elevated rates of all-cause hospitalization and infections. We estimated the incidence of all-cause hospitalization and infection-related hospitalization in the first 2 years of life among HEU children and compared this to HIV-unexposed uninfected (HUU) children in the U.S. Among HEU children, we evaluated associations of maternal HIV disease-related factors during pregnancy with risk of infant hospitalization.
We evaluated HEU children enrolled in the Surveillance Monitoring for ART Toxicities (SMARTT) Study dynamic cohort of the Pediatric HIV/AIDS Cohort Study (PHACS) network who were born 2006-2017 and followed from birth. Data on HUU children were obtained from the Medicaid Analytic Extract database, restricted to states participating in SMARTT. We compared rates of first hospitalization, total hospitalizations, first infection-related hospitalization, total infection-related hospitalizations, and mortality between HEU and HUU children using Poisson regression. Among HEU children, multivariable Poisson regression models were fit to evaluate associations of maternal HIV factors with risk of hospitalization.
Our analysis included 2,404 HEU and 3,605,864 HUU children. HEU children had ~2 times greater rates of first hospitalization, total hospitalizations, first infection-related hospitalization, and total infection-related hospitalizations compared to HUU children (Figure 1). There was no significant difference in mortality. Among HEU children, maternal HIV disease factors, including viral load, CD4 count, antiretroviral regimen, and mode of HIV acquisition, were not associated with hospitalization rates.
Compared to HUU, HEU children in the US have nearly twice the rate of hospitalization and infection-related hospitalization in the first 2 years of life, consistent with studies in other countries. Closer monitoring of HEU infants for infection and further elucidation of immune mechanisms is needed.
Figure 1: Rates of Hospitalization and Mortality in First Two Years of Life (95% CI) among SMARTT HEU vs. Medicaid HUU in the United States, 2007-2016
S. M. Labuda,
D. Kacanek, None
K. Patel, None
J. Jao, None
K. Huybrecthts, None
S. Hernandez-Diaz, None
E. G. Chadwick, Abbott Labs: Shareholder , stock dividends . AbbVie: Shareholder , stock dividends .
G. Scott, None
S. Burchett, None
C. Smith, None
F. Kakkar, None
R. Van Dyke, Giliad Sciences: Grant Investigator , Research grant .