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Journal of Tropical Pediatrics Advance Access published online on January 21, 2009
Journal of Tropical Pediatrics, doi:10.1093/tropej/fmn118
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Published by Oxford University Press. All rights reserved [2009]. For Permissions, please email: journals.permissions@oxfordjournals.org

Patterns and Predictors of CD4 T-cell Counts Among Children Born to HIV-infected Women in Tanzania

Roland Kupkaa,b, Gernard I. Msamangac, Said Aboudd, Karim P. Manjie, Christopher Dugganf and Wafaie W. Fawzia,g

aDepartment of Nutrition, Harvard School of Public Health, Boston, MA, USA
bUnited Nations Children's Fund, Regional Office for West and Central Africa, Dakar, Senegal
cDepartment of Community Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
dDepartment of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
eDepartment of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
fDivision of Gastroenterology and Nutrition, Children's Hospital, Boston, MA, USA
gDepartment of Epidemiology, Harvard School of Public Health, Boston, MA, USA

Correspondence: Roland Kupka, DSc, Department of Nutrition, Harvard School of Public Health, 665 Huntington Avenue, Boston, MA 02115, USA. E-mail <rkupka{at}post.harvard.edu>


  Abstract

We assessed age-specific CD4 T-cell counts and their determinants among Tanzanian children born to HIV-infected mothers to address a major research gap. A total of 474 HIV-uninfected and 69 HIV-infected children were followed until age of 12 months. Maternal predictors were measured during pregnancy and child predictors at birth and throughout the follow up. Child CD4 T-cell counts were evaluated at the age of 3 months and subsequent 3-month intervals; they decreased linearly among HIV-infected (β = –8 cells per week; 95% CI –12 to –4; P = 0.0003) and increased linearly among HIV-uninfected children (β = 4 cells/week; 95% CI 2–7; P = 0.0008). Decreased child counts were predicted by low child anthropometry, maternal HIV stage ≥2, and maternal mid-upper arm circumference <27 cm among HIV-infected children; and by weight-for-height <–2 z-score, maternal HIV stage ≥2, maternal erythrocyte sedimentation rate <81 mm/h and maternal haemoglobin <8.5 g/dl among HIV-uninfected children. The maternal and child predictors described may serve as intervention targets among HIV-exposed children.


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