Infectious morbidity among children HIV-exposed uninfected in South Africa.

BACKGROUND

Increased risk of infectious morbidity and hospitalization has been reported during infancy among children HIV-exposed uninfected (CHEU) compared to children HIV-unexposed uninfected (CHUU). However, data on risks beyond infancy are limited.

METHODS

We enrolled pregnant women with and without HIV from a primary healthcare facility in a lower income area in Cape Town, South Africa (2017-2018). We tracked their children's HIV test results and hospitalizations using routine electronic healthcare data. We previously reported increased rates of infectious-cause hospitalization among CHEU in the first year of life, and now extend the analysis to cover the period from age 1 to less than 5 years. Using random-effects Poisson regression, we calculated adjusted incidence rate ratios (aIRR) for infectious-cause hospitalization among CHEU vs. CHUU, clustered by infant and adjusted for child sex and vaccination status, maternal age and education, and housing type.

RESULTS

Among 446 CHEU and 455 CHUU, 147 admissions occurred from age 1 to less than 5  years; with 59% ( n  = 87) due to infections. All-cause hospitalization occurred in 9.2% of CHEU and 10.5% of CHUU; infectious-cause hospitalization occurred in 6.5% of CHEU and 7.3% of CHUU with crude incidence rates of 2.4 per 100 child-years for both groups [IRR = 1.0; 95% confidence interval (CI) 0.6-1.6]. Adjusted analyses showed no evidence of increased hospitalization among CHEU (aIRR = 0.71; 95% CI 0.36-1.41).

CONCLUSION

Elevated risk of infectious-cause hospitalization among CHEU did not persist beyond the first year of life. These findings highlight infancy as a key window for targeted interventions, while providing reassurance regarding longer term infectious morbidity risk.