Variability of Growth in Children Starting Antiretroviral Treatment in Southern Africa

Gsponer, T., Weigel, Ralf ORCID: https://orcid.org/0000-0001-9034-2634, Davies, M.-A., Bolton, C., Moultrie, H., Vaz, P., Rabie, H., Technau, K., Ndirangu, J., Eley, B., Garone, D., Wellington, M., Giddy, J., Ehmer, J., Egger, M. and Keiser, O. (2012) 'Variability of Growth in Children Starting Antiretroviral Treatment in Southern Africa'. Pediatrics, Vol 130, Issue 4, e966-e977.

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Abstract

BACKGROUND: Poor growth is an indication for antiretroviral therapy (ART) and a criterion for treatment failure. We examined variability in growth response to ART in 12 programs in Malawi, Zambia, Zimbabwe, Mozambique, and South Africa.

METHODS: Treatment naïve children aged <10 years were included. We calculated weight for age z scores (WAZs), height for age z scores (HAZs), and weight for height z scores (WHZs) up to 3 years after starting ART, by using the World Health Organization standards. Multilevel regression models were used.

RESULTS: A total of 17 990 children (range, 238–8975) were followed for 36 181 person-years. At ART initiation, most children were underweight (50%) and stunted (66%). Lower baseline WAZ, HAZ, and WHZ were the most important determinants of faster catch-up growth on ART. WAZ and WHZ increased rapidly in the first year and stagnated or reversed thereafter, whereas HAZ increased continuously over time. Three years after starting ART, WAZ ranged from −2.80 (95% confidence interval [CI]: −3.66 to −2.02) to −1.98 (95% CI: −2.41 to −1.48) in children with a baseline z score < −3 and from −0.79 (95% CI: −1.62 to 0.02) to 0.05 (95% CI: −0.42 to 0.51) in children with a baseline WAZ ≥ −1. For HAZ, the corresponding range was −2.33 (95% CI: −2.62 to −2.02) to −1.27 (95% CI: −1.58 to −1.00) for baseline HAZ < −3 and −0.24 (95% CI: −0.56 to 0.15) to 0.84 (95% CI: 0.53 to 1.16) for HAZ ≥ −1.

CONCLUSIONS: Despite a sustained growth response and catch-up growth in children with advanced HIV disease treated with ART, normal weights and heights are not achieved over 3 years of ART.

Item Type:	Article
Subjects:	WC Communicable Diseases > Virus Diseases > Acquired Immunodeficiency Syndrome. HIV Infections > WC 503 Acquired immunodeficiency syndrome. HIV infections WC Communicable Diseases > Virus Diseases > Acquired Immunodeficiency Syndrome. HIV Infections > WC 503.2 Therapy WC Communicable Diseases > Virus Diseases > Acquired Immunodeficiency Syndrome. HIV Infections > WC 503.5 Complications WS Pediatrics > WS 20 Research (General)
Faculty: Department:	Groups (2002 - 2012) > Clinical Group
Digital Object Identifer (DOI):	https://doi.org/10.1542/peds.2011-3020
Depositing User:	Lynn Roberts-Maloney
Date Deposited:	14 Jan 2015 10:44
Last Modified:	06 Feb 2018 13:08
URI:	https://archive.lstmed.ac.uk/id/eprint/4729

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