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

OBJECTIVES:

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.

METHODS:

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.

RESULTS:

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.

CONCLUSIONS:

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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By:  Feucht UD¹, van Bruwaene L^1,2, Becker PJ³, Kruger M⁴.

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.

Trop Med Int Health. 2016 Feb 23. doi: 10.1111/tmi.12685.

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