Height and timing of growth spurt during puberty in young people living with vertically acquired HIV in Europe and Thailand

doi:10.1097/qad.0000000000002294

Cited by 9 publications

(14 citation statements)

References 18 publications

(30 reference statements)

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“…The mean age at ART initiation was 6.5 years. Children who started ART later (≥6 years) had a higher risk of poor growth and a delayed PHV compared to those who started earlier (<6 years), which is similar to other published studies [ 11 , 20 , 21 ]. There were multiple reasons for delayed ART initiation in African children, including ART guidelines current at the time, tuberculosis co-infection, lack of human resources, socio-economic obstacles and incorrect disease classification of disease severity [ 22 , 23 ].…”

Section: Discussionsupporting

confidence: 90%

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

et al. 2022

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Background The majority children living with HIV infection now survive into adulthood because of effective antiretroviral therapy (ART), but few data exist on their growth during adolescent years. This study investigated growth patterns and evaluated factors associated with suboptimal growth in adolescents with perinatally-acquired HIV infection. Methods This retrospective cohort study included HIV-infected adolescents, aged 13 to 18 years, with at least 5 years of ART follow-up at a large HIV clinic in the Gauteng Province, South Africa. Weight-for-age Z-scores (WAZ), height-for-age Z-scores (HAZ) and body mass index (BMI)-for-age Z-scores were calculated using World Health Organization (WHO) growth standards. Growth velocity graphs were generated utilising the mean height change calculated at 6-monthly intervals, using all available data after ART initiation, to calculate the annual change. Other collected data included WHO HIV disease staging, CD4%, HIV viral loads (VLs), ART regimens and tuberculosis co-infection. Results Included were 288 children with a median age of 6.5 years (IQR 4.2;8.6 years) at ART initiation, and 51.7% were male. At baseline the majority of children had severe disease (92% WHO stages 3&4) and were started on non-nucleoside reverse transcriptase inhibitor-based regimens (79.2%). The median CD4% was 13.5% (IQR 7.9;18.9) and median HIV viral load log 5.0 (IQR 4.4;5.5). Baseline stunting (HAZ <-2) was prevalent (55.9%), with a median HAZ of -2.2 (IQR -3.1;-1.3). The median WAZ was -1.5 (IQR -2.5;-0.8), with 29.2% being underweight-for-age (WAZ <-2). The peak height velocity (PHV) in adolescents with baseline stage 3 disease was higher than for those with stage 4 disease. Being older at ART start (p<0.001) and baseline stunting (p<0.001) were associated with poorer growth, resulting in a lower HAZ at study exit, with boys more significantly affected than girls (p<0.001). Conclusions Suboptimal growth in adolescents with perinatally-acquired HIV infection is a significant health concern, especially in children who started ART later in terms of age and who had baseline stunting and is more pronounced in boys than in girls.

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Section: Discussionsupporting

confidence: 90%

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

et al. 2022

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“…In line with other studies [ 11 , 12 , 24 ], growth spurts tended to occur later in those starting ART at older ages, though we observed differences between male and female individuals. In female individuals, older age at ART initiation was associated with later and more intense growth spurts, though this was less pronounced in the sub-Saharan regions than elsewhere.…”

Section: Discussionsupporting

confidence: 92%

“…In particular, children in Asia-Pacific had lower z scores than in other regions. In previous analyses conducted in paediatric HIV cohorts in Europe and Thailand in EPPICC, the associations between stunting and pubertal growth modelled using SITAR models were similar when WHO and Thai specific reference data were used [ 11 ].…”

Section: Discussionmentioning

confidence: 94%

“…A US study found much of the difference in age at sexual maturity between ALWPHIV and young people HIV-exposed uninfected can be explained by poorer growth among the ALWPHIV earlier in life [ 9 ]. Despite potential catch-up growth after starting ART, some studies have observed delays in pubertal development associated with growth deficits present at ART initiation, irrespective of age at ART initiation [ 11 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

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Global variations in pubertal growth spurts in adolescents living with perinatal HIV

Crichton

Jesson

Aké-Assi

et al. 2023

Aids

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Objective: To describe pubertal growth spurts among adolescents living with perinatally acquired HIV (ALWPHIV) on antiretroviral therapy (ART). Design: Observational data collected from 1994 to 2015 in the CIPHER global cohort collaboration. Methods: ALWPHIV who initiated ART age less than 10 years with at least four height measurements age at least 8 years were included. Super Imposition by Translation And Rotation (SITAR) models, with parameters representing timing and intensity of the growth spurt, were used to describe growth, separately by sex. Associations between region, ART regimen, age, height-for-age (HAZ), and BMI-for-age z-scores (BMIz) at ART initiation (baseline) and age 10 years, and SITAR parameters were explored. Results: Four thousand seven hundred and twenty-three ALWPHIV were included: 51% from East and Southern Africa (excluding Botswana and South Africa), 17% Botswana and South Africa, 6% West and Central Africa, 11% Europe and North America, 11% Asia-Pacific, and 4% Central, South America, and Caribbean. Growth spurts were later and least intense in sub-Saharan regions. In females, older baseline age and lower BMIz at baseline were associated with later and more intense growth spurts; lower HAZ was associated with later growth spurts. In males, older baseline age and lower HAZ were associated with later and less intense growth spurts; however, associations between baseline HAZ and timing varied by age. Lower HAZ and BMIz at 10 years were associated with later and less intense growth spurts in both sexes. Conclusion: ALWPHIV who started ART at older ages or already stunted were more likely to have delayed pubertal growth spurts. Longer-term follow-up is important to understand the impact of delayed growth.

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“…Whereas studies demonstrating growth and pubertal delay in male and female HIV-infected children have been conducted in the developed settings of Europe and the United States [ 14 – 17 ], similar studies in either of the sexes or both sexes have been conducted in sub-Saharan Africa as well [ 18 – 22 ]. In southeast Nigeria, a previous study in this locality focused on the female sex alone by investigating sexual maturation in perinatally HIV-infected girls aged 8–17 years [ 23 ].…”

Section: Introductionmentioning

confidence: 99%

Physical growth and sexual maturation of perinatally HIV-infected adolescent males in a southeast Nigerian tertiary hospital: a comparative cross-sectional study

2022

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Background The advent of highly-active anti-retroviral therapy (HAART) has resulted in the survival of children with Human Immunodeficiency Virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS) into adolescence. Their prolonged survival has translated into co-morbidities like endocrine deficiencies which may manifest as growth and pubertal delay. This study aimed to determine the physical growth and sexual maturation of perinatally HIV-infected adolescent males and compare them with those of age-matched HIV-negative controls. Methods We conducted a comparative cross-sectional study of 104 perinatally HIV-infected males on HAART aged 10 to 19 years, and 104 age-matched HIV-negative males who served as controls. The subjects and controls were enrolled and assessed at a Nigerian tertiary hospital over six months. Anthropometric measurements such as weight, height, and BMI were obtained and Z scores for age were derived for weight, height, and BMI to determine physical growth using WHO AnthroPlus software. Sexual maturation was assessed using the method proposed by Marshall and Tanner. Data analysis and appropriate statistics were conducted with the Statistical Package for Social Sciences (SPSS) version 25 Chicago IL. A p-value < 0.05 was adopted as the level of statistical significance. Results The mean height, weight, and BMI Z scores of the subjects were all lower than those of the controls. The difference between the mean weight of the subjects (44.60 ± 13.32 kg) and the controls (49.97 ± 13.58 kg) was statistically significant (t = 2.88, p = 0.004). Similarly, the difference between the mean BMI Z-scores of the subjects (-0.96 ± 1.95) and the controls (-0.10 ± 0.86) was statistically significant (t = 4.10, p = < 0.001). The subjects showed a delay in pubic hair and testicular development for Stages 1, 2, and 3. Duration of HAART did not significantly affect the BMI of subjects who were in three groups: undernutrition, normal nutrition, and overnutrition (Kruskal-Wallis test, p = 0.30). Conclusion Perinatal HIV infection negatively affects physical growth and the onset of pubic-hair development (PH 2) despite the duration of HAART. We recommend that screening for weight deficit or pubertal delay should form part of the management protocol for HIV-infected male children on HAART.

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Height and timing of growth spurt during puberty in young people living with vertically acquired HIV in Europe and Thailand

Cited by 9 publications

References 18 publications

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

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

Global variations in pubertal growth spurts in adolescents living with perinatal HIV

Physical growth and sexual maturation of perinatally HIV-infected adolescent males in a southeast Nigerian tertiary hospital: a comparative cross-sectional study

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