Haemoglobin levels and growth of South African infants aged 6–12 months exposed to maternal HIV infection

Abstract

Introduction: Anaemia is a significant public health concern in women of reproductive age and children under five years old, particularly in high HIV-prevalent settings.
Objective: This study analysed differences in haemoglobin levels and growth between human immunodeficiency virus (HIV)-exposed-but-uninfected (HEU) and HIV-unexposed-uninfected (HUU) infants, and further determined correlations between haemoglobin levels and growth at 6, 9, and 12 months in the Siyakhula study.
Results: At 6, 9, and 12 months postpartum, the maternal mean haemoglobin levels and anaemia status differed significantly by HIV status (p < 0.05), while HEU and HUU infants showed similar mean haemoglobin levels and anaemia status. Anaemia was prevalent in HEU infants at 6 (27%), 9 (33%), and 12 (30%) months. The HEU infants had lower weight-for-age Z-scores (WAZ) and mid-upper-arm circumference-for-age Z-scores (MUACZ) than HUU infants at 6, 9, and 12 months (p < 0.05). At 12 months, HEU infants had lower mean weight-for-length Z-scores (WLZ) than the HUU infants (-0.2 ± 1.2 vs. 0.2 ± 1.2; p = 0.020). The HEU infants had a higher prevalence of stunting at 6 months (16% vs. 8%; p = 0.044), and less breastfeeding at 9 (36% vs. 57%; p = 0.013) and 12 (25% vs. 48%; p = 0.005) months than the HUU infants. In HEU infants, positive correlations were found between infants’ haemoglobin levels and WAZ (p = 0.039), LAZ (p = 0.007), and MUACZ (p = 0.039) at 9 months, and with WAZ (p = 0.018) and WLZ (p = 0.017) at 12 months, while negative correlations were found between infant haemoglobin levels and any breastfeeding practices at 6, 9, and 12 months (p = 0.026; p < 0.001; p = 0.036).
Conclusion: Maternal HIV infection can negatively impact infant growth, and anaemia remains a public health concern in South Africa.
Keywords: anaemia, anthropometry, growth, haemoglobin, HIV exposure, infants, nutrition