Rates of Hospitalization and Infection-Related Hospitalization Among Human Immunodeficiency Virus (HIV)–Exposed Uninfected Children Compared to HIV-Unexposed Uninfected Children in the United States, 2007–2016
Authors: Labuda Sarah M , Huo Yanling , Kacanek Deborah , Patel Kunjal , Huybrechts Krista , Jao Jennifer , Smith Christiana , Hernandez-Diaz Sonia , Scott Gwendolyn , Burchett Sandra , Kakkar Fatima , Chadwick Ellen G , Van Dyke Russell B ,   Pediatric HIV/AIDS Cohort Study, Chadwick Ellen , Ann Sanders Margaret , Malee Kathleen , Hunter Scott , Shearer William , Paul Mary , McMullen-Jackson Chivon , Eser-Jose Ruth , Harris Lynnette , Purswani Murli , Mirza Baig Mahoobullah , Villegas Alma , Gaye-Robinson Lisa , Dia Cooley Jawara , Blood James , Garvie Patricia , Borkowsky William , Deygoo Sandra , Lewis Jennifer , Dieudonne Arry , Bettica Linda , Johnson Juliette , Surowiec Karen , Knapp Katherine , Utech Jill , Wilkins Megan , Russell-Bell Jamie , Rosario Nicolas , Angeli-Nieves Lourdes , Olivera Vivian , Kohlhoff Stephan , Dennie Ava , Kaye Jean , Van Dyke Russell , Craig Karen , Sirois Patricia , Hutto Cecelia , Hickman Paige , Marullo Dan , Spector Stephen A , Figueroa Veronica , Loughran Megan , Nichols Sharon , McFarland Elizabeth , Barr Emily , Kwon Christine , Glenny Carrie , Rathore Mobeen , Stowers Kristi , Mahmoudi Saniyyah , Maraqa Nizar , Almira Rosita , Hayani Karen , Richardson Lourdes , Smith Renee , Miller Alina , Scott Gwendolyn , Mogollon Maria , Fernandez Gabriel , Cuadra Anai , Frederick Toni , Davtyan Mariam , Vinas Jennifer , Morales-Avendano Guadalupe , Rodriguez Zoe M , Torres Lizmarie , Scalley Nydia 
Published: August 2019

Abstract

Background
Studies from multiple countries have suggested impaired immunity in perinatally human immunodeficiency virus (HIV)–exposed uninfected children (HEU), with elevated rates of all-cause hospitalization and infections. We estimated and compared the incidence of all-cause hospitalization and infection-related hospitalization in the first 2 years of life among HEU and HIV-unexposed uninfected children (HUU) in the United States. Among HEU, we evaluated associations of maternal HIV disease–related factors during pregnancy with risk of child hospitalization.

Methods
HEU data from subjects enrolled in the Surveillance Monitoring for Antiretroviral Therapy Toxicities Study (SMARTT) cohort who were born during 2006–2017 were analyzed. HUU comparison data were obtained from the Medicaid Analytic Extract database, restricted to states participating in SMARTT. We compared rates of first hospitalization, total hospitalizations, first infection-related hospitalization, total infection-related hospitalizations, and mortality between HEU and HUU using Poisson regression. Among HEU, multivariable Poisson regression models were fitted to evaluate associations of maternal HIV factors with risk of hospitalization.

Results
A total of 2404 HEU and 3 605 864 HUU were included in the analysis. HEU children had approximately 2 times greater rates of first hospitalization, total hospitalizations, first infection-related hospitalization, and total infection-related hospitalizations compared with HUUs. There was no significant difference in mortality. Maternal HIV disease factors were not associated with the risk of child infection or hospitalization.

Conclusions
Compared with HUU, HEU children in the United States have higher rates of hospitalization and infection-related hospitalization in the first 2 years of life, consistent with studies in other countries. Closer monitoring of HEU infants for infection and further elucidation of immune mechanisms is needed.