Correlates and Outcomes Associated with Levels of Intestinal Fatty Acid Binding Protein (I-FABP) in a Cohort of Uninfected HIV Exposed and Unexposed 2-Year-Old Healthy Kenyan Children

Abstract

Background: While previous studies have indicated worse developmental outcomes in HIV-exposed uninfected (HEU) children compared to their HIV-unexposed uninfected (HUU) peers, the biological mechanisms driving these disparities remain unclear. Additionally, intestinal inflammation in childhood may impair growth and neurodevelopment. We evaluated predictors and developmental outcomes associated with fatty acid-binding protein (I-FABP), a biomarker of acute intestinal inflammation, in a cohort of healthy Kenyan HEU and HUU. Methods: This study used data from the Linda Kizazi birth cohort in Nairobi, Kenya, to examine I-FABP levels at 24 months and associated predictors and outcomes. We compared I-FABP levels between HEU and HUU children, assessed the association between early-life exposures and 24 month I-FABP levels, and evaluated associations with 48-month growth and neurodevelopment (cognition and executive function) using linear regression models stratified by HIV exposure non-infection status. Results: Among 127 children (64 HEU, 63 HUU), median I-FABP levels did not significantly differ by HIV exposure. No early-life exposure was significantly associated with I-FABP levels. However, higher I-FABP at 24 months was associated with greater weight-for-age gains from 24 to 48 months in HEU children and was significantly associated with lower executive function scores overall, and lower learning scores in HEU. Conclusions: Overall higher I-FABP level was associated with lower executive function and cognition, but not HIV exposure status, suggesting that intestinal inflammation may influence child neurodevelopment. These findings highlight the need for further studies to examine intestinal inflammation as a mechanism explaining developmental disparities in HEU children.