Does exposure to antiretroviral therapy affect growth in the first 18 months of life in uninfected children born to HIV-infected women?

Uninfected children born to HIV-infected women are exposed antenatally to antiretroviral therapy, but it is uncertain whether this affects growth in early life. We analyzed weight, height, and occipitofrontal circumference (OFC) in 1912 children from a cohort study: 1304 had no or monotherapy exposure and 608 had combination therapy exposure. The mean z-score for birth weight or OFC did not differ by exposure category in 1513 term children or in 78 bom at < 34 weeks; the 266 bom from 34 to 36 weeks were heavier if exposed to combination therapy. Children with combination therapy exposure bom at 34 to 36 weeks reached the 25th centile for weight and OFC earlier than those not exposed born at 34 to 36 weeks (median: birth vs. 3 months; P = 0.003 [weight], P = 0.004 [OFC]), whereas children exposed to combination therapy born at < 34 weeks reached the 25th centile for OFC later than those bom at < 34 weeks not exposed (median: 15 vs. 7 months; P = 0.004). Gestational age and maternal illicit drug use were strongly associated with growth, but the effect of combination therapy exposure was marginal (adjusted coefficients: weight, -0.10 [P = 0.019]; height, -0.12 [P = 0.008]; and OFC, -0.14 [P = 0.001]). Although the effect of combination therapy exposure is minimal, long-term monitoring of these children is important.