Impact on Weight and Height With the Use of HAART in HIV-Infected Children

Guillén, Sara; Ramos, José Tomás; Resino, Rosa; Bellón, José María; Muñoz, Mercedes

doi:10.1097/01.inf.0000257427.19764.ff

Cited by 82 publications

(76 citation statements)

References 11 publications

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“…10,[13][14][15][16][17][18] Similarly, studies from developed countries such as The Netherlands, United States, and Spain where PI-based regimen was mainly used also showed improvement in growth after starting ART. [7][8][9] Study from a large pediatric cohort in the United States and Uganda found that significant improvement in weight preceded that in height. 8,11 However, the rate and degree to which improvement in growth occurred could not be compared among these studies because of the different criteria used to define growth failure and the difference in severity of HIV infection at the time ART was started.…”

Section: Discussionmentioning

confidence: 99%

“…[4][5][6] Many studies from developed countries using protease inhibitor (PI)-based ART regimen showed an improvement in growth of HIV-infected children after initiating ART. [7][8][9] Studies from Kenya and Uganda also showed significant improvements in weight and height as well as immunological and virologic parameters of perinatally HIVinfected children after ART initiation. 10,11 We had reported on the efficacy of ART in children participating in Thailand's national access to antiretroviral program.…”

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confidence: 99%

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Reversal of Growth Failure in HIV-Infected Thai Children Treated with Non-Nucleoside Reverse Transcriptase Inhibitor–Based Antiretroviral Therapy

Aurpibul

Puthanakit

Taecharoenkul

et al. 2009

AIDS Patient Care and STDs

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Growth failure is a common problem in HIV-infected children. The extent to which this growth failure could be reversed after the children receive antiretroviral therapy (ART) is not known. This study assessed the incidence of growth failure in HIV-infected Thai children, impact of ART on growth, and the predictors of growth reversal after initiating ART. Growth parameters and other characteristics were extracted from the database of a prospective cohort of HIV-infected children (age 15 years) who were enrolled to initiate non-nucleoside reverse transcriptase inhibitor-based ART between August 2002 and May 2007. Body weight and height measurements, CD4 cell counts, plasma HIV RNA levels were collected at baseline and 24-week intervals. A total of 225 HIV-infected children were included, 116 (51%) were males. The median age at baseline was 7.4 years (interquartile range [IQR] 5.2-9.8). Fifty-three percent were in Centers for Disease Control and Prevention (CDC) category C and 54% had CD4 percentage 5 or less. The mean (standard deviation [SD]) of baseline weight-for-age (WAZ) and height-forage (HAZ) z-scores were À2.02 (1.17) and À2.22 (1.51). The median follow-up time was 216 weeks (IQR 120-240). The cumulative probability of growth reversal among the 179 subjects with growth failure at entry was 58% (95% confidence interval [CI] 49-67) at week 240. In a multivariate Cox regression model, higher entry WAZ ( p < 0.001) and HAZ ( p < 0.001), use of a nevirapine-based regimen (compared to efavirenz, p ¼ 0.027) and larger CD4% gains to week 48 ( p < 0.001) were significant predictors of growth reversal after initiating ART. NNRTI-based ART leads to a substantial improvement in growth of HIV-infected children. Initiation of ART before the children developed growth failure should be encouraged.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Reversal of Growth Failure in HIV-Infected Thai Children Treated with Non-Nucleoside Reverse Transcriptase Inhibitor–Based Antiretroviral Therapy

Aurpibul

Puthanakit

Taecharoenkul

et al. 2009

AIDS Patient Care and STDs

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“…Baseline growth parameters in our cohort were worse than reported from the United States [28,29] and Spain [30] but similar to those reported from Thailand [10] and India [31]. Aurbipol et al report higher entry WAZ and HAZ, use of nevirapine-based regimen rather than efavirenz, and larger CD4% gains to week 48 as predictors of growth reversal after initiating ARV [32].…”

Section: Discussionmentioning

confidence: 39%

Clinical manifestations and treatment outcomes in HIV-1-infected children receiving antiretroviral therapy in Karachi, Pakistan

Mir

Qamar

Baig‐Ansari

et al. 2014

J Infect Dev Ctries

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Introduction: The impact of antiretroviral (ARV) therapy on immunological and growth parameters in HIV-positive children in Pakistan has not been reported to date. Methodology: A retrospective chart review of children diagnosed with HIV at the Sindh AIDS Control Proigramme (SACP) and registered at the Aga Khan University, Karachi, between January 2005 and 2013 was conducted, evaluating clinical and laboratory profiles of HIV+ ARV+ children for ARV impact (serial height and weight CD4 and viral counts). Results: Twenty-four children were diagnosed and registered as HIV positive over five years, and 20 were started on ARV. Six were excluded from analysis (ARV duration < 6 months). Nine (64.3%) of 14 fulfilled WHO criteria for treatment failure at a median duration of 25 weeks (IQR 18-32) on ARV and underwent resistance genotyping. All nine had NNRTI resistance, two had high-grade NRTI resistance (≥ 4 thymidine analog mutations). Median age at start of ARV was 71.5 weeks (IQR 37.5-119). Median baseline weight for age (WAZ) and height for age (HAZ) z-scores changed from -1.94 to 1.69 and -1.99 to -1.59, respectively, after six months of therapy. Median CD4 percentage and viral load at baseline changed from 13.8 to 17.8, while viral load changed from 285 × 10 4 copies to zero at six months. Conclusions: ARV improved absolute CD4 and viral counts. Weight and height did not improve significantly, highlighting the need for aggressive nutritional rehabilitation. Early development of ARV resistance in these children requires formal assessment.

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“…As reported by others, control of viral replication is associated with sustained growth (16,17) . With respect to European children, it has previously been reported that while uninfected and HIV-infected infants did not present significant weight differences at the time of birth, the latter group was on average 460 g lighter at 3 months of age (3) .…”

Section: Discussionmentioning

confidence: 69%

Longitudinal growth of infants born to HIV-1-infected mothers in Belo Horizonte, Brazil

Fausto

Carneiro

Antunes

et al. 2009

Public Health Nutr.

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Objective: To prospectively evaluate growth parameters assessed by weight and length in infected and uninfected infants born to HIV-1-infected mothers and followed from birth to 18 months. Methods: A cohort consisting of ninety-seven uninfected and forty-two infected infants born to HIV-infected mothers enrolled from 1995 to 2004, and admitted during their first 3 months of life at a referral Pediatric AIDS Clinic in Belo Horizonte, Brazil. Infants were followed until 18 months of age. Data were analysed using mixed-effects linear regression models for weight and length fitted by restricted maximum likelihood. Results: Infected infants contributed to 466 weight and 411 recumbent length measurements. Uninfected infants provided 924 weight and 907 length measurements. Mean birth weight and length were similar in both groups, 3?1 (SD 0?4) and 3?0 (SD 0?5) kg, and 48?7 (SD 1?4) and 48?8 (SD 2?9) cm for uninfected and infected infants, respectively. However, HIV-1 infection had an early impact in growth impairment: at 6 months of age, HIV-infected children were 1 kg lighter and 2 cm shorter than the uninfected. Conclusions: Growth faltering in weight, but not length, in HIV-infected children in Brazil is more marked than that reported in a European cohort, probably reflecting background nutritional deficiencies and concomitant infections. In these settings, early and aggressive nutritional management in HIV-1-infected infants should be a priority intervention associated with the antiretroviral therapy. (2) , of which 9965 (2?7 %) were perinatally infected children. Antiretroviral therapy (ART) for the prevention of mother-to-child transmission of HIV-1 (PMTCT) was introduced in Brazil in 1995, resulting in significant reduction of transmission rates (2) . The assessment of weight at birth and of child growth is one of the indicators of their nutritional status. In developed countries, HIV vertically infected children present similar weight and length at birth compared to those of non-infected children (3) . Differences in weight and length growth of infected and uninfected children start to appear in the first months of life (3,4) . The growth assessment of HIV-infected children is important both to determine the disease stage and prognosis and to assess the effectiveness and toxicity of ART regimens and to study the nutritional implications of the infection (5) . Growth seems to be one of the most sensitive indicators of the disease progression in children living with HIV/AIDS (6) . Even in children who have been using antiretroviral drugs, the absence of growth is a poor prognostic indicator. Weight gain is also an important indicator of ART effectiveness (7) . For these reasons, anthropometric methods are useful to monitor the disease progression and to assess response to treatment. Studies involving infants born to HIV-1-infected mothers can provide useful insights into the nutritional implications of the infection, and can contribute to the establishment of intervention strategies for this segment of the...

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Impact on Weight and Height With the Use of HAART in HIV-Infected Children

Abstract: HIV-infected children experienced a continued catch-up in weight and height 5 years after starting HAART. Virologic control is related to sustained growth.

Cited by 82 publications

References 11 publications

Reversal of Growth Failure in HIV-Infected Thai Children Treated with Non-Nucleoside Reverse Transcriptase Inhibitor–Based Antiretroviral Therapy

Reversal of Growth Failure in HIV-Infected Thai Children Treated with Non-Nucleoside Reverse Transcriptase Inhibitor–Based Antiretroviral Therapy

Clinical manifestations and treatment outcomes in HIV-1-infected children receiving antiretroviral therapy in Karachi, Pakistan

Longitudinal growth of infants born to HIV-1-infected mothers in Belo Horizonte, Brazil

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