Gray, D.MWedderburn, C.JMacGinty, R.PMcMillan, LJacobs, CStadler, J.AHall, G.LZar, H.J2024-06-092024-06-092020-03-15Gray DM, Wedderburn CJ, MacGinty RP, McMillan L, Jacobs C, Stadler JAM, Hall GL, Zar HJ. Impact of HIV and antiretroviral drug exposure on lung growth and function over 2 years in an African Birth Cohort. AIDS. 2020 Mar 15;34(4):549-558. doi: 10.1097/QAD.0000000000002444.10.1097/QAD.000000000000244410.1097/QAD.0000000000002444https://journals.lww.com/aidsonline/Fulltext/2020/03150/Impact_of_HIV_and_antiretroviral_drug_exposure_on.7.aspxhttps://hdl.handle.net/11288/596460Objective: To assess the impact of HIV and antiretroviral exposure without infection on lung growth and function over the first 2 years of life. Design: Prospective observational study of an African birth cohort, Drakenstein Child Health Study. Method: Infants enrolled antenatally had lung function measured at 6 weeks, 1 and 2 years. HIV-infected women received antiretroviral therapy (ART) as per local guidelines. The association between HIV and antiretroviral exposure with lung function was assessed using mixed effects modelling. Results: Of 1143 infants born, two HIV-infected infants were excluded from analysis; 909 (80%) infants had lung function collected at 6 weeks [190 (21%) were HIV-exposed uninfected (HEU)]; 782 (69%) at 1 year and 741 (65%) at 2 years. At 6 weeks HEU infants had larger tidal volume compared with HIV-unexposed infants (1.13 ml, confidence interval: 0.02–2.23, P = 0.045). High maternal viral load was associated with a 17% lower expiratory flow over 2 years (0.17, confidence interval 0.00–0.34, P = 0.046). First-line ART initiated during pregnancy was associated with lower infant tidal volume at 6 weeks compared with those who initiated ART before pregnancy (−2.7 ml, −5.31 to −0.10, P = 0.042), and low maternal CD4+ cell counts associated with lower infant tidal over 2 years (−11.1 ml, −18.58–3.58, P = 0.004). Conclusion: HIV exposure is associated with altered lung function in early life, with a vulnerable HEU subgroup based on maternal disease severity, immunological compromise and ART exposure. These data highlight the importance of ongoing surveillance of respiratory health in HEU children.enAttribution 3.0 United Stateshttp://creativecommons.org/licenses/by/3.0/us/HIV exposureHIVLung functionInfantAntiretroviral therapyArticleAIDS