Epstein Barr Virus Infection Is Associated with Compromised Growth in Infants Born to HIV-1 Infected Women

Objective: Infants exposed to and infected with human immunodeficiency virus (HIV) experience high mortality rates, high rates of morbidity, and poor growth. Poor growth is associated with increased mortality rates in infancy as well as impaired neurocognitive development, and poorer educational attainment in the long-term. Other infections acquired in infancy may also be accompanied by acute growth faltering. Epstein Barr (EBV) is a common pathogen that is commonly acquired in infancy and has been causally linked to serious long-term clinical sequelae in children and adults such as mononucleosis and certain malignancies. To date, there have been no studies examining the effect of EBV infection on infant growth. This study examined the association between EBV infection, EBV viral load and infant growth.;Methods: This study utilized data from a prospective observational study conducted in Kenya from 1999-2003. Infants born to HIV-infected mothers (n=125) were followed for 1 year with serial anthropometric measurements. EBV DNA viral loads were measured using quantitative real-time PCR. Infant weight and length were recorded at monthly study visits. Linear mixed effects models were used to determine the effect of EBV infection and EBV viral load on infant's weight-for-age (WAZ), height-for-age (HAZ), and weight-for-height (WHZ) scores. Models were adjusted for baseline z-scores for all infants, and additionally for HIV-1 viral load in HIV-infected infants.;Results: The cohort included 75 HIV-infected and 50 HIV exposed uninfected (HIV-EU) infants who were followed for 1 year. EBV infection was associated with altered z-scores in HIV-infected and HIV- EU infants. HIV-infected infants had WAZ on average 0.83 (p=0.01) lower and WHZ scores in average 0.89 (p=0.05) lower than EBV negative infants. HIV- EU infants had HAZ scores on average 1.7 (p=0.04) lower than EBV negative infants. EBV viral load had a statistically significant association with z-scores in HIV-infected infants; each 1-log increase in EBV viral load was associated with a 0.29 lower WHZ score (p<0.001), and 0.28 lower WAZ score (p<0.001). In HIV-EU infants, each 1-log increase in EBV viral load was associated with 0.14 lower WAZ (p=0.05).;Conclusion: EBV may be a contributing factor in impaired growth in HIV-infected and HIV- EU infants. Delaying EBV infection might improve growth during the first year of life for these infants.