Longitudinal Trajectories of Growth and Development in HIV-Exposed Uninfected Children from a Long-Term Birth Cohort — 8 Regions, 3 PLADs, China, 2017–2024

Objective This study examined growth and development trajectories in Human Immunodeficiency Virus (HIV) exposed children aged 0–3 years, identified key influencing factors, and generated evidence to support early developmental promotion in this population. Methods This prospective cohort study enrolled pregnant women who delivered between January 2017 and June 2021 and followed their infants until 3 years of age. Participants were drawn from a mother-to-child HIV transmission cohort established across Guangxi Zhuang Autonomous Region, Yunnan Province, and Xinjiang Uygur Autonomous Region. Chi-square tests were used to compare differences between groups, and generalized estimating equations (GEE) were applied to identify factors influencing growth and nutritional outcomes in HIV-exposed children. Results The cohort comprised 1,227 mother-child pairs: 411 in the exposed group (HIV-infected mothers) and 816 in the control group (non-HIV-infected mothers). The malnutrition rate among HIV-exposed children in the study regions was 12.00%. Relative to the control group, HIV-exposed children demonstrated significantly lower height and weight gains and a higher prevalence of malnutrition (P<0.05). GEE analysis identified a household per capita monthly income exceeding 3,000 yuan as a protective factor against malnutrition [adjusted odds ratio (aOR)=0.924, 95% confidence interval (CI): 0.877, 0.974], while a maternal history of stillbirth (aOR=1.055, 95% CI: 1.008, 1.104) and neonatal low birth weight (aOR=1.377, 95% CI: 1.267, 1.497) were independent risk factors across all follow-up periods. Female sex was also associated with a modestly elevated risk of malnutrition compared with male sex (aOR=1.048, 95% CI: 1.017, 1.079). Conclusions HIV-exposed children in the study regions demonstrated modestly poorer overall growth and development compared with non-exposed peers. These findings underscore the importance of targeted nutritional interventions, early developmental surveillance, and timely correction of growth abnormalities in this vulnerable population.