Stunting and growth velocity of adolescents with perinatally acquired HIV: differential evolution for males and females. A multiregional analysis from the IeDEA global paediatric collaboration

Abstract

Introduction Stunting is a key issue for adolescents with perinatally acquired HIV (APH) that needs to be better understood. As part of the IeDEA multiregional consortium, we described growth evolution during adolescence for APH on antiretroviral therapy (ART). Methods We included data from sub‐Saharan Africa, the Asia‐Pacific, and the Caribbean, Central and South America regions collected between 2003 and 2016. Adolescents on ART, reporting perinatally acquired infection or entering HIV care before 10 years of age, with at least one height measurement between 10 and 16 years of age, and followed in care until at least 14 years of age were included. Characteristics at ART initiation and at 10 years of age were compared by sex. Correlates of growth defined by height‐for‐age z‐scores (HAZ) between ages 10 and 19 years were studied separately for males and females, using linear mixed models. Results Overall, 8737 APH were included, with 46% from Southern Africa. Median age at ART initiation was 8.1 years (interquartile range (IQR) 6.1 to 9.6), 50% were females, and 41% were stunted (HAZ<−2 SD) at ART initiation. Males and females did not differ by age and stunting at ART initiation, CD4 count over time or retention in care. At 10 years of age, 34% of males were stunted versus 39% of females (p < 0.001). Females had better subsequent growth, resulting in a higher prevalence of stunting for males compared to females by age 15 (48% vs. 25%) and 18 years (31% vs. 15%). In linear mixed models, older age at ART initiation and low CD4 count were associated with poor growth over time (p < 0.001). Those stunted at 10 years of age or at ART initiation had the greatest growth improvement during adolescence. Conclusions Prevalence of stunting is high among APH worldwide. Substantial sex‐based differences in growth evolution during adolescence were observed in this global cohort, which were not explained by differences in age of access to HIV care, degree of immunosuppression or region. Other factors influencing growth differences in APH, such as differences in pubertal development, should be better documented, to guide further research and inform interventions to optimize growth and health outcomes among APH.

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

“…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 ].…”

“…These findings were similar to a study done by Jesson et al . [ 11 ], which also showed more normalization of growth patterns in HIV-infected girls compared to boys, which is currently not fully explained. In our study the age at PHV in girls was delayed by about 12 months and their PHV was 5.9 cm/year, while in boys the age at PHV was delayed by 24 months and the PHV was low at 5.7 cm/year, with the duration and magnitude of the pubertal growth spurt lower than the WHO reference population.…”

“…Previous studies, mainly from high-income settings, have documented an association between paediatric HIV infection and growth failure as well delayed pubertal onset [7][8][9][10][11]. Implicated factors included HIV-related opportunistic infections, underlying malnutrition and chronic inflammation [8,12].…”

Transition to Dolutegravir Is Associated With an Increase in the Rate of Body Mass Index Change in a Cohort of Virally Suppressed Adolescents

“…There are high rates of stunting among ALHIV [ 17 ]. This cohort was marginally stunted on average and we also observed a slight decrease in the rate of HAZ change after DTG transition.…”

“…Regardless of the specific antiretroviral regimen, children and young adolescents living with HIV (C/ALHIV) have improvements in weight-for-age z score (WAZ), height-for-age z score (HAZ), and BMI-for-age z score (BAZ) in the first 2 years after ART initiation [ 16 ]. Despite improvements, 30% of adolescent males and 15% of adolescent females living with HIV in sub-Saharan Africa are stunted toward the end of adolescence [ 17 , 18 ]. Female ALHIV may also experience increases in percentage body fat compared with male ALHIV and female HIV-negative adolescents [ 19 ].…”