Growth improvement following antiretroviral therapy initiation in children with perinatally-acquired HIV diagnosed in older childhood in Zimbabwe: a prospective cohort study

Abstract

Background Children who initiate antiretroviral therapy (ART) before age 5 years can recover height and weight compared to uninfected peers, but growth outcomes are unknown for children initiating ART at older ages. We investigated factors associated with growth failure at ART initiation and modelled growth by age on ART. Methods We conducted secondary analysis of cohort of children aged 6–15 years late-diagnosed with HIV in Harare, Zimbabwe, with entry at ART initiation in 2013–2015. Factors associated with height-for-age (HAZ), weight-for-age (WAZ) and BMI-for-age (BAZ) z-scores <− 2 (stunting, underweight and wasting respectively) at ART initiation were assessed using multivariable logistic regression. These outcomes were compared at ART initiation and 12 month follow-up using paired t-tests. HAZ and BAZ were modelled using restricted cubic splines. Results Participants (N = 302; 51.6% female; median age 11 years) were followed for a median of 16.6 months (IQR 11.0–19.8). At ART initiation 34.8% were stunted, 34.5% underweight and 15.1% wasted. Stunting was associated with age ≥ 12 years, CD4 count < 200 cells/μl, tuberculosis (TB) history and history of hospitalisation. Underweight was associated with older age, male sex and TB history, and wasting was associated with older age, TB history and hospitalisation. One year post-initiation, t-tests showed increased WAZ (p = 0.007) and BAZ (p = 0.004), but no evidence of changed HAZ (p = 0.85). Modelling showed that HAZ and BAZ decreased in early adolescence for boys on ART, but not girls. Conclusion Stunting and underweight were prevalent at ART initiation among late-diagnosed children, and HAZ did not improve after 1 year. Adolescent boys with perinatally acquired HIV and late diagnosis are particularly at risk of growth failure in puberty.

Assessment of Endocrine Function in HIV-Infected Adolescent Girls at a Tertiary Centre in Zimbabwe. A Cross Sectional Study

“…Despite good immunological control of HIV infection, stunting remains a major issue in these HIV-infected adolescents (21). Since HIV-infected infants are now beginning treatment early, new studies have shown that stunting is not as prevalent as in this study, where ART was not started in infancy (12).…”

“…A study performed on Zimbabwean and Ugandan HIV-infected adolescents to assess the age of attaining Tanner stages with reference to the age of ART initiation showed that the mean age of ART initiation was 9.4 years and that delaying ART initiation signi cantly delayed pubertal development and menarche (11). In another study performed in Zimbabwe, stunting and underweight were more prevalent at ART initiation among late-diagnosed adolescents, especially boys with perinatally acquired HIV infection, and those diagnosed late were particularly at risk of growth failure in puberty (12).…”