Risks of infections among HIV exposed infants during the first 18 months of life in Western Kenya

Abstract

BACKGROUND
Infants exposed to HIV are more vulnerable to infections compared to those not HIV exposed. The occurrence and risks of infections among these infants are less understood. High maternal viral load can result in advanced disease, low maternal survival rates and puts the infant at higher risk of having early T- cell abnormality [24].

AIM
This study aimed at characterizing the infections among HIV Exposed Infants (HEI) and establishing the risk factors associated with infections for interventions that will improve their health outcomes.

METHODOLOGY
A cohort study was conducted using records of HEI enrolled at the PMTCT program in Kisumu County Referral Hospital (KCRH) in western Kenya, between January 2015 and December 2017. Using a simple random sampling technique, 260 records were obtained and a structured checklist resembling HEI follow-up cards was developed for quality assurance in data abstraction. Targeting those who had completed the 18 months follow-up, died or confirmed HIV positive during the process. Excluded were transfers, loss to follow-up and infants who had incomplete records. Data entry was done using Microsoft Excel then exported to SPSS version 20 for data analysis.

RESULTS
A total of 46 infants reported different infections with an incidence rate of 17.3 new cases per 100 persons. Respiratory tract infections were the leading cause of infections contributing to 34.6% (18) of the infections. Other infections were malaria 17.4% (9), gastroenteritis 8 15.4% (8), oral thrush 11.5% (6), measles 9.6% (5), UTIs 5.8% (3). The risks to infections were high maternal viral load (OR 8.20 CI 3.32-20.25, p≤ 0.001), incomplete Co-trimoxazole prophylaxis (OR 2.23 CI 0.91- 5.50, p≤0.050) and mixed feeding (OR 2.59 CI 1.05 -6.36, p≤0.040). High burden of gastroenteritis peaking at around the 7 th month of the 18 month was recorded.

CONCLUSION
High maternal viral load, incomplete Co-trimoxazole prophylaxis dosage and mixed feeding are a risk to infections among HEI. These findings provide critical information for health promotion and improvement of PMTCT interventions. Lifespan approach in understanding and protecting these infants from risks and infections, pneumonia in particular is crucial.

RECOMENDATIONS
Home delivery and breastfeeding for only 1 year compared to the recommended breastfeeding duration of 2 years should be discouraged. Future studies be conducted in multiple sites involving HIV infant comparator to enrich the findings.