Growth in Virologically Suppressed HIV-Positive Children on Antiretroviral Therapy

Abstract

Background Combination antiretroviral therapy (ART) suppresses viral replication in HIV-infected children. The growth of virologically suppressed children on ART has not been well documented. We aimed to develop dynamic reference curves for weight-for-age z scores (WAZ) and height-for-age z scores (HAZ). Methods Children aged <11 years at ART initiation with continuously undetectable viral loads (<400 copies/ml) treated at seven South African ART programs with routine viral load monitoring were included. We used multilevel models to define trajectories of WAZ and HAZ up to 3 years and developed a web application to monitor trajectories in individual children. Results A total of 4,876 children were followed for 7,407 person-years. Analyses were stratified by baseline z-scores and age, which were the most important predictors of growth response. The youngest children showed the most pronounced increase in weight and height initially but catch-up growth stagnated after 1–2 years. Three years after starting ART, WAZ ranged from −2.2 (95% Prediction interval −5.6 to 0.8) in children with baseline age >5 years and z-score <−3 to 0.0 (−2.7 to 2.4) in children with baseline age <2 years and WAZ >−1. For HAZ the corresponding range was −2.3 (−4.9 to 0.3) in children with baseline age>5 years and z-score <−3 to 0.3 (−3.1 to 3.4) in children with baseline age 2–5 years and HAZ >−1. Conclusions We have developed an online tool to calculate reference trajectories in fully suppressed children. The web application could help to define ‘optimal’ growth response and identify children with treatment failure.

Growth and the pubertal growth spurt in South African adolescents living with perinatally-acquired HIV infection

“…The majority of our participants were virologically suppressed at study exit. Contrary to our findings, a study done in Southern Africa by Keiser et al [29] concluded that baseline high VL was associated with poor growth, but with a small effect estimate. Good adherence to ART is usually associated with successful viral suppression and hence, disease control and a reduction in opportunistic infections, with improved childhood growth.…”

Growth and pubertal development in HIV-infected adolescents

“…Findings regarding association of immunological status (CD4 count, WHO stage) with growth recovery have been inconsistent, often showing no association after accounting for baseline growth measures [12,16,20,22,25]. In addition, catch up growth often appears to stagnate after 1–2 years on ART even among children with virologic suppression [10,26].…”

“…Other low-cost screening instruments such as mid-upper arm circumference may be useful for identifying those at greatest risk of growth failure [43]. Development of screening tools for assessing growth rates on ART relative to reference standards may also improve identification of growth failures [26].…”

Most Early-Treated Children With Perinatally Acquired HIV Have Preserved Lung Function at School Age

“…[9][10][11] Delayed ART initiation is additionally associated with suboptimal immune reconstitution, bone development, and attainment of growth potential. [12][13][14][15] A study in Zimbabwe that followed up 197 children with a median age of 11 years over 2 years found that ART initiation earlier in life could prevent an annual deterioration of 0.06 in the forced expiratory volume in 1 second (FEV 1 ) z score. 16 In addition, a higher body mass index (BMI)-for-age z score at the time of initiating follow-up was associated with an increase in 0.31 FEV 1 z score per year.…”