Decreased growth among antiretroviral drug and HIV exposed uninfected versus unexposed children in Malawi and Uganda Objective: To compare growth among antiretroviral drug and maternal-HIV exposed uninfected (AHEU) versus age-and-sex-matched HIV unexposed uninfected (HUU) children. Design: Prospective cohort of AHEU children identified from the PROMISE trial (NCT01061151: clinicaltrials.gov registry) and age-and-sex-matched HUU controls from child-wellness clinics, enrolled (09/2013–10/2014) in Malawi and Uganda. Methods: Weight-for-age (WAZ), length-for-age (LAZ), weight-for-length (WLZ), and head-circumference-for-age (HCAZ) z-scores were derived at 12 and 24 months-of-age. Wilcoxon Rank-Sum and Fischer's exact tests were used for unadjusted exposure group comparisons. Generalized-Estimating-Equations models estimated adjusted relative risks (aRR) for poor growth outcomes. Results: Overall, 471 (50.5%) AHEU and 462 (49.5%) HUU children were assessed. Ugandan AHEU compared to HUU children had significantly lower mean LAZ (p < 0.001) and WAZ (p < 0.001) at 12 and 24 months-of-age and HCAZ (p = 0.016) at 24 months, with similar but not significant differences among Malawian AHEU and HUU children. The risk of stunting (more than two standard deviations below the WHO-population LAZ median) was increased among AHEU versus HUU children: aRR = 2.13 (95% confidence interval (CI): 1.36, 3.33), p = 0.001 at 12-months, and aRR = 1.67 (95% CI: 1.16, 2.41), p = 0.006 at 24-months-of-age in Uganda; and aRR = 1.32 (95% CI: 1.10, 1.66), p = 0.018, at 24-months-of-age in Malawi. The risk of HCAZ below WHO median was increased among AHEU versus HUU children at 24-months-of-age, aRR = 1.35 (95% CI: 1.02, 1.79), p = 0.038 in Uganda; and aRR = 1.35 (95% CI: 0.91, 2.02), p = 0.139 in Malawi. Conclusions: Perinatal exposures to maternal-HIV and antiretroviral drugs were associated with lower LAZ (including stunting), WAZ and HCAZ at 24 months-of-age compared HUU children. Correspondence to Jim Aizire, MBCHB, MHS, PhD, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe St., E7132B. Tel: +10-502-8988; e-mail: jaizire1@jhu.edu Received 5 May, 2019 Revised 31 August, 2019 Accepted 2 September, 2019 Copyright © 2019 Wolters Kluwer Health, Inc.