Friday, March 11, 2016

Growth in HIV-Infected Children on Long-Term Antiretroviral Therapy

To describe growth in HIV-infected children on long-term antiretroviral therapy (ART) and to assess social, clinical, immunological and virological factors associated with suboptimal growth.

This observational cohort study included all HIV-infected children at an urban ART site in South Africa who were younger than 5 years at ART initiation and with more than 5 years of follow-up. Growth was assessed using weight-for-age Z-scores (WAZ), height-for-age Z-scores (HAZ) and body mass index (BMI)-for-age Z-scores (BAZ). Children were stratified according to pre-treatment anthropometry and age. Univariate and mixed linear analysis were used to determine associations between independent variables and weight and height outcomes.

The majority of the 159 children presented with advanced clinical disease (90%) and immunosuppression (89%). Before treatment underweight, stunting and wasting were common (WAZ<-2= 50%, HAZ<-2= 73%, BAZ<-2= 19%). Weight and BMI improved during the initial 12 months, while height improved over the entire 5-year period. Height at study exit was significantly worse for children with growth impairment at ART initiation (p<0.001), although infants (<1 year) demonstrated superior improvement in terms of BMI (p=0.04). Tuberculosis was an independent risk factor for suboptimal weight (p=0.01) and height (p=0.02) improvement. Weight gain was also hindered by lack of electricity (p=0.04). Immune reconstitution and virological suppression were not associated with being underweight or stunted at study end point.

Malnutrition was a major clinical concern for this cohort of HIV-infected children. Early ART initiation, tuberculosis co-infection management and nutritional interventions are crucial to ensure optimal growth in HIV-infected children. This article is protected by copyright. All rights reserved.

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1Department of Paediatrics, Kalafong hospital, University of Pretoria, Pretoria, South Africa.
2University Hospital Gasthuisberg, Leuven, Belgium.
3Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.
4Department of Paediatrics and Child Health, University of Stellenbosch, Tygerberg, South Africa.
 2016 Feb 23. doi: 10.1111/tmi.12685.

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