Comparison of height-for-age and weight-for-age <i>Z</i> -scores between HIV-exposed and -unexposed children aged 3–10 years old

Despite effective antiretroviral therapy (ART), children born to women living with HIV but who remain uninfected (CHEU) have poorer growth compared to children born to women living without HIV (CHU). Few studies have compared growth beyond early childhood. In a cross-sectional study, we enrolled CHEU and CHU aged 3-10 years. Growth Z-scores were calculated using WHO growth standards (weight-for-age [WAZ], height-for-age [HAZ], body mass index [BMIZ] [5-10 years], and head circumference-for-age [HCZ] [3-5 years]). Growth faltering was defined as Z-scores of <-2 SDs. We compared CHEU/CHU growth Z-scores and prevalence of growth faltering using generalized linear models and binomial regression, adjusting for sociodemographic characteristics. We enrolled 2001 CHEU and 200 CHU. The median age was similar in both categories. CHEU were more likely to be orphaned and vulnerable children (22%) and to have shorter breastfeeding period (12 vs. 24 months). CHEU mothers were older, had fewer years of education, and were more likely to be single parents. Most CHEU mothers were on ART during pregnancy with the enrolled child. CHEU had significantly lower HAZ (adjusted mean difference [aMD] -0.41, 95% CI -0.66, -0.17, P = .001) and WAZ (aMD -0.25, 95% CI -0.43, -0.08, P = .005). CHEU had 1.7 times higher prevalence of stunting (HAZ <-2) in unadjusted models, which was attenuated after adjustment. There were no differences in BMIZ or HCZ. Older CHEU aged 3-10 years had lower WAZ and HAZ scores than CHU. Poorer growth outcomes persisted after adjustment for socio-economic factors, suggesting a potential role of biological factors.