Association between infant feeding practices and infant growth by maternal HIV and antiretroviral therapy status: a prospective study in Cape Town, South Africa

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BACKGROUND: Infants who are HIV-Exposed Uninfected (HEU) may experience adverse growth outcomes compared to those HIV Unexposed Uninfected (HUU). However, there are limited data from the context of universal antiretroviral therapy (ART) and promotion of extended breastfeeding (BF) for infants HEU. We compared the growth of infants HEU and HUU enrolled January 2017-July 2018 from the same community in Cape Town, South Africa. METHODS: Data were collected during pregnancy and at seven days, 10 weeks, six and 12 months postpartum. Infant birth weight and length were converted to weight-for-age and length-for-age z-scores (WAZ, LAZ) using Intergrowth-21st software. We determined WAZ, LAZ and weight-for-length z-scores (WLZ) at postpartum visits using World Health Organization Anthro survey analyzer tool. Linear mixed effects models were fit to compare WAZ, LAZ and WLZ between infants HEU and HUU and assess associations with infant feeding practices, social support and food security, adjusting for infant HIV exposure status, time (study visit), maternal age, employment and marital/cohabiting status, household food security status and duration of BF. RESULTS: Among 796 mother-infant pairs, infants HEU (50%) had shorter median BF duration [73 days; interquartile range (IQR) 12-222 vs 209 (IQR 72-365) for infants HUU (p < 0.001)]. Complementary feeding was introduced early with a high proportion having sweet beverages and no differences between infants HEU and HUU. Among all infants WAZ increased at 12 months vs 7 days [β = 0.621; 95% CI 0.523 to 0.720] but LAZ decreased [β = -1.260; 95% CI -1.406 to -1.114], with higher WLZ [β = 0.171; 95% CI 0.026 to 0.316] at 12 months vs 10 weeks and no impact of HIV exposure or BF. Infants of mothers married/cohabiting (proxy for social support) had higher WAZ and LAZ. Food security was associated with higher WLZ [β = 0.341; 95% CI: 0.029 to 0.653]. CONCLUSIONS: In our study, overall infants experienced suboptimal length growth but gained weight with no difference by HIV status or BF. Being married/cohabiting improved all growth parameters and food security improved growth in weight. Public health interventions should enhance social support and food security to promote optimal growth.

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