Early treated HIV-infected children remain at risk of growth retardation during the first five years of life: Results from the ANRS-PEDIACAM cohort in Cameroon

Abstract

Background Long-term growth in HIV-infected infants treated early in resource-limited settings is poorly documented. Incidence of growth retardation, instantaneous risk of death related to malnutrition and growth parameters evolution during the first five years of life of uninfected and early treated HIV-infected children were compared and associated factors with growth retardation were identified. Methods Weight-for-age (WAZ), weight-for-length (WLZ), and length-for-age (LAZ) Z-scores were calculated. The ANRS-PEDIACAM cohort includes four groups of infants with three enrolled during the first week of life: HIV-infected (HI, n = 69), HIV-exposed uninfected (HEU, n = 205) and HIV-unexposed uninfected (HUU, n = 196). The last group included HIV-infected infants diagnosed before 7 months of age (HIL, n = 141). The multi-state Markov model was used to describe the incidence of growth retardation and identified associated factors. Results During the first 5 years, 27.5% of children experienced underweight (WAZ<-2), 60.4% stunting (LAZ<-2) and 41.1% wasting (WLZ<-2) at least once. The instantaneous risk of death observed from underweight state (35.3 [14.1–88.2], 84.0 [25.5–276.3], and 6.0 [1.5–24.1] per 1000 person-months for 0–6 months, 6–12 months, and 12–60 months respectively) was higher than from non-underweight state (9.6 [5.7–16.1], 20.1 [10.3–39.4] and 0.3 [0.1–0.9] per 1000 person-months). Compared to HEU, HIL and HI children were most at risk of wasting (adjusted HR (aHR) = 4.3 (95%CI: 1.9–9.8), P<0.001 and aHR = 3.3 (95%CI: 1.4–7.9), P = 0.01 respectively) and stunting for HIL (aHR = 8.4 (95%CI: 2.4–29.7). The risk of underweight was higher in HEU compared to HUU children (aHR = 5.0 (CI: 1.4–10.0), P = 0.001). Others associated factors to growth retardation were chronic pathologies, small size at birth, diarrhea and CD4< 25%. Conclusions HIV-infected children remained at high risk of wasting and stunting within the first 5 years period of follow-up. There is a need of identifying suitable nutritional support and best ways to integrate it with cART in pediatric HIV infection global care.

Under-nutrition and associated factors among human immunodeficiency virus-infected children in sub-Saharan Africa: A systematic review and meta-analysis.

“…The highest prevalence of stunting was reported from a study in Cameron 77.0% [42], and the least was from a study in Mail 20.0% [49]. Similarly, the highest prevalence of underweight was reported from a study in Nigeria 58.6% [8], and the minimum was from a study in Tanzania 6.8% [45].…”

Nutrition in HIV-Infected Infants and Children: Current Knowledge, Existing Challenges, and New Dietary Management Opportunities

“…Abnormalities in weight and height are adverse nutritional outcomes in children living with HIV (11,54) and can be considered markers of disease progression and significant contributors to morbidity and mortality (54). Poor nutritional status of HIV-infected children, including those who have already started ART, is closely associated with increased risk of premature death.…”

“…Causes of growth impairment in HIV-infected children may include reduced food intake and opportunistic infections that affect food consumption, nutrient absorption, and metabolism leading to weight loss (8). HIV-infected children remain at high risk of wasting and stunting within the first 5 y of follow-up treatment (11). ART has been shown to have a positive effect on weight and, to a lesser extent, on growth (57).…”

“…Thus, adequate nutrition of HIV-infected infants becomes critically important to prevent undernutrition, particularly because of their nutritional needs and dependency on adults for their care (8). This has been illustrated by studies that have shown a high prevalence of undernutrition among HIV-infected children (9)(10)(11)(12).…”

Killer-Cell Immunoglobulin-Like Receptors (KIR) in HIV-Exposed Infants in Cameroon

“…In 2018, Cameroon had 23,000 (22,000-41,000) new HIV infections and 18,000 (25,000-33,000) AIDS-related deaths [ 16 ]. The estimated number of new paediatric HIV infections was 4500 in 2017, and the vertical transmission rate was 13% in breastfed infants [ 17 ]. Before the wide availability of antiretroviral therapy (ART), the majority of HIV-infected infants would die under the age of 2 years with 33% dying before their first birthday [ 18 ].…”