Malnutrition, Growth Response and Metabolic Changes Within the First 24 Months After ART Initiation in HIV-infected Children Treated Before the Age of 2 Years in West Africa

Jesson, Julie; Dahourou, Désiré Lucien; Folquet, Madeleine Amorissani; Malateste, Karen; Yonaba, Caroline; N’Gbeche, Marie-Sylvie; Ouédraogo, S. M.; Mea-Assande, Véronique; Amani-Bossé, Clarisse; Blanche, Stéphane; Timité-Konan, M.; Leroy, Valériane

doi:10.1097/inf.0000000000001932

Cited by 12 publications

(12 citation statements)

References 36 publications

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“…In Tanzania [16] and South Africa [25] reporting growth evolution over 6 and 5 years respectively, similar trends were observed with a strong weight increase in the first 6 months on ART, followed by stabilization overtime, and a steady height increase, but insufficient to fully compensate height deficiency [16]. A substantial part of HIV-infected children remains malnourished in the long-term in our study, as seen elsewhere [18,19,29,30]. The most severely malnourished children at ART initiation were those with the better gains overtime, but these gains were often insufficient to reach similar values as non-malnourished children.…”

Section: Discussionsupporting

confidence: 85%

Growth in the first 5 years after antiretroviral therapy initiation among HIV‐infected children in the IeDEA West African Pediatric Cohort

Jesson

Ephoevi-Ga

Desmonde

et al. 2019

Tropical Med Int Health

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objective To describe growth evolution and its correlates in the first 5 years of antiretroviral therapy (ART) initiation among HIV-infected children followed up in West Africa.methods All HIV-infected children younger than 10 years followed in the IeDEA pWADA cohort while initiating ART, with at least one anthropometric measurement within the first 5 years of treatment were included in the study. Growth was described according to the WHO child growth standards, using Weight-for-age Z-score (WAZ), Height-for-age Z-score (HAZ) and Weight-for-Height/BMI-for-age Z-score (WHZ/BAZ). Growth evolution and its correlates, measured at ART initiation, were modelled in individual linear mixed models for each anthropometric indicator, with a spline term added at the 12-, 24-and 9-month time point for WAZ, HAZ and WHZ/BAZ, respectively.results Among the 4156 children selected (45% girls, median age at ART initiation 3.9 years [IQR interquartile range 1.9-6.6], and overall 68% malnourished at ART initiation), important gains were observed in the first 12, 24 and 9 months on ART for WAZ, HAZ and WHZ/BAZ, respectively. Correlates at ART initiation of a better growth evolution overtime were early age (<2 years of age), severe immunodeficiency for age, and severity of malnutrition.conclusions Growth evolution is particularly strong within the first 2 years on ART but slows down after this period. Weight and height gains help to recover from pre-ART growth deficiency but are insufficient for the most severely malnourished. The first year on ART could be the best period for nutritional interventions to optimize growth among HIV-infected children in the long-term.

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Section: Discussionsupporting

confidence: 85%

Growth in the first 5 years after antiretroviral therapy initiation among HIV‐infected children in the IeDEA West African Pediatric Cohort

Jesson

Ephoevi-Ga

Desmonde

et al. 2019

Tropical Med Int Health

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“…The impact of this strategy may be higher in low‐income regions due to rarer availability of laboratory techniques that allow close monitoring of the response to ART. An advanced immunological stage or the presence of a high viral load has been associated with a poorer nutritional status . This agrees with the findings of this study, where the presence of acute underweight increased fourfold the risk of moderate‐severe immunodeficiency.…”

Section: Discussionsupporting

confidence: 92%

“…This predominance corroborates the results of previous studies . The proportion of malnutrition at the time of HIV diagnosis in this population is similar to that documented for children from other sub‐Saharan countries , where 50–55% were reported as underweight, 33‐70% as stunted and 16–36% as wasted. In Mali, children under 15 years of age showed 23% acute malnutrition, 23% chronic and 12% mixed at the time of HIV diagnosis.…”

Section: Discussionsupporting

confidence: 91%

Nutritional, clinical and immunological status of children at HIV diagnosis in the continental region of Equatorial Guinea

Aguilera‐Alonso¹,

Grasa

Hernández

et al. 2019

Tropical Med Int Health

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objective To evaluate the nutritional, clinical and immunological status of children at HIV diagnosis in the continental region of Equatorial Guinea.methods Children <18 years diagnosed with HIV between 2009 and 2017 were included. Clinical, immunological and nutritional data were collected. Weight-for-height, weight-for-age and height-forage Z-scores were calculated using WHO Child Growth Standards. The population was assessed in two equal periods (2009-2013 and 2014-2017) from the time of diagnosis.results A total of 213 children were diagnosed with HIV (49.3% males), median age 3.8 years (IQR: 1.5-8.2). A total of 121 cases (56.8%) were at WHO clinical stage III, and 53 (24.9%) were at WHO clinical stage IV. CDC immunological stage II was diagnosed in 51/130 (39.2%) and CDC stage III in 44/130 (33.8%). About 56.2% of children were underweight (weight-for-age <À2 SD); 20.1% moderately and 36.1% severely so. About 27.6% of children were wasted (weight-for-height <À2 SD); 11.9% moderately and 15.7% severely so. About 56.3% of children were stunted (heightfor-age <À2 SD); 20.7% moderately and 35.6% severely so. The prevalence of wasting was higher in children ≤5 years than in children >5 years (36.4% vs. 19.1%, P = 0.026). In the second period, the prevalence of moderate-severe immunodeficiency decreased (87.2% to 67.0%, P = 0.018), without significant differences in the other nutritional or clinical data. Severe underweight was a risk factor for moderate-severe immunodeficiency (aOR: 4 [95% CI: 1.4-11.4], P = 0.010).conclusions We highlight a high proportion of malnutrition at the time of HIV diagnosis in Guinea´s paediatric population. Early diagnosis of HIV infection is a priority, achievable by training Guinea´s physicians to suspect HIV early, introducing HIV molecular diagnostic techniques and ensuring intensive nutritional treatment.Sustainable Development Goals (SDGs): SDG 2 (zero hunger), SDG 3 (good health and well-being), SDG 10 (reduced inequalities), SDG 17 (partnerships for the goals)

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“…These two pathologic conditions interact and can each impede physical growth, cognitive, and social development of the child [4, 10]. ART initiation can help to resolve malnutrition as shown by many authors [11–14]. But, growth improvement seems to be greater for children initiated early on ART compared with those initiated at older ages [11–13].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2019

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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.

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Malnutrition, Growth Response and Metabolic Changes Within the First 24 Months After ART Initiation in HIV-infected Children Treated Before the Age of 2 Years in West Africa

Abstract: Prevalence of malnutrition was high before ART initiation. Even though growth improved on ART, some children remained malnourished even after 2 years of ART, highlighting the need for more active nutritional support.

Cited by 12 publications

References 36 publications

Growth in the first 5 years after antiretroviral therapy initiation among HIV‐infected children in the IeDEA West African Pediatric Cohort

Growth in the first 5 years after antiretroviral therapy initiation among HIV‐infected children in the IeDEA West African Pediatric Cohort

Nutritional, clinical and immunological status of children at HIV diagnosis in the continental region of Equatorial Guinea

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

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