Interventions to Improve Health Outcomes of Children with HIV Exposure Crucial

With over 16 million HIV-exposed uninfected (HEU) children- born to women living with HIV but remain uninfected- in the world, there is need for more interventions to ensure that these children have improved health outcomes which enable them to thrive.

According to a study titled “ Risk and rates of hospitalisation in young children: A prospective study of a South African birth cohort,” HEU children are at greater risk of hospitalisation in infancy compared to other children who were not exposed to HIV.

The study, published in the PLOS Global Public Health journal, found that HEU children were in hospital nearly twice as much as HIV-unexposed uninfected (HUU) children with hospital days lasting about six days compared to about four days for HUU children.

Dr. Catherine Wedderburn, Chief Research Officer and Paediatric Doctor, Department of Paediatrics & Child Health and the Neuroscience Institute, University of Cape Town, South Africa notes that the greater risk of hospitalisation is likely to be because of biological and socio-economic reasons.

Some of these include being born prematurely and less breastfeeding which includes shorter periods of breastfeeding and not exclusively breastfeeding for six months.

She observed that other research has shown immune system differences and the importance of social factors such as food insecurity.

“We also found that high maternal HIV viral load was a risk factor for child hospitalisation – that is when the mother’s HIV was not well-controlled, then children were sicker,” Dr. Wedderburn said, adding

“This means that mothers can protect their children by managing their own HIV well by taking their antiretrovirals. Mums often put themselves last, but actually looking after their own physical and mental health is really important.”

Another factor associated with hospitalisation across all children was delayed vaccination, showing the importance of timely vaccinations, she added.

Generally, the study found that most hospitalisations occurred in the first year of life, with the highest rates being between 0-6 months and the lowest rates being 12-24 months for all children.

Amongst hospitalisations following discharge after birth, 83% of them were due to infection, with pneumonia being the most common cause. They found that respiratory syncytial virus (RSV) was responsible for 31% of pneumonia cases with children 0–6 months being more affected by it. Promisingly, there are now new interventions being developed to prevent RSV.

Besides pneumonia, gastroenteritis (diarrhoea) was the second most common cause for hospitalisation with more HEU children being affected than HUU. Exclusive breastfeeding duration and breastfeeding for the first year were associated with reduced risk of gastroenteritis specifically.

Other infections included meningitis, sepsis as well as ear, urinary tract, and eye infections. Other causes for hospitalisations comprised injuries, trauma, burns, seizures, jaundice, or nutritional issues (failure to thrive, malnutrition, or anaemia) which accounted for 17% of cases studied.

“Other studies have highlighted that some, but not all, children who are HIV-exposed and uninfected also have increased stunting of growth and poorer language and motor development in this early period, which has the potential to impact their lives later and have long-term consequences for them as individuals,” Dr. Wedderburn noted.

She observed that preventing the spread of HIV remains crucial. There is need for education, destigmatization, empowering women and ensuring there is good access to care and antiretroviral treatment.

Additionally, managing HIV, by ensuring that those infected with HIV take their drugs to ensure viral suppression, will ensure better outcomes for children.

Generally, Dr. Wedderburn observed that encouraging breastfeeding, getting timely vaccinations, seeking healthcare early when children are sick, and educating the public that children born prematurely and with HIV exposure risk hospitalisation, will promote good health outcomes for all children.

Read the article at Science Africa