Younger age at HAART initiation is associated with more rapid growth reconstitution

Abstract

Objectives Patterns of growth following highly active antiretroviral therapy (HAART) administration among children are not well defined. The objective of this study was to determine rates and predictors of growth reconstitution among children on HAART. Methods A study was conducted among HIV-1-infected children initiating HAART at an HIV treatment clinic in Kenya. Kaplan–Meier survival curves and Cox proportional hazards regression models compared catch-up growth (Z-score ≥0) at 12 months post-HAART. Multivariate linear mixed-effects models determined rates and predictors of growth following HAART. Results One hundred and seventy-three HIV-1-infected children initiated HAART with a median age of 4.7 years [interquartile range (IQR) 2.4, 7.0]. At baseline, children below 3 years had lower weight-for-age (WAZ) and weight-for-height (WHZ) Z-scores than children 3–5 and 6–10 years (WAZ: P = 0.03; WHZ: P = 0.006). Adjusting for baseline growth, children below 3 years were two to three-fold more likely to attain population age-norms (Z-score = 0) than 6–10 years (WAZ: P = 0.055; WHZ: P = 0.005) at 12 months post-HAART. After adjustment, children below 3 years had higher increases in WAZ and WHZ following HAART than 6–10 years (WAZ: P = 0.006; WHZ: P = 0.005). Children at WHO stage at least 3 at baseline experienced more rapid WHZ reconstitution (P = 0.002). Food supplementation while on HAART was associated with increased monthly gains in weight indices (WAZ: P = 0.001; WHZ: P = 0.005), and multivitamins were associated with greater increases in height (P < 0.01). Conclusion Following HAART initiation, younger children had more rapid catch-up to the population-average weight of their peers than older children, demonstrating growth benefit of earlier HAART. In addition to HAART, food supplementation and multivitamins may also accelerate growth reconstitution.

Challenges of malnutrition care among HIV-infected children on antiretroviral treatment in Africa

“…Children severely immunodeficient at initiation of ART may have a better growth outcome than non-immunodeficient children at initiation [32,37,41]. Other results do not prove any association between the level of immunodeficiency and nutritional recovery.…”

“…Nutritional problems cannot be fully explained by the effects of HIV in non-immunodeficient children, and other factors, independent of the infection, may explain why treatments are insufficient to restore the nutritional status. Furthermore, a better growth trend was observed in children with a more advanced clinical stage at ART initiation [32,37,41].…”

“…Several authors have reported that growth retardation due to HIV could be corrected with ART initiation [24,[31][32][33][37][38][39][40][41]. Several factors can influence the response to antiretroviral therapy, and therefore the nutritional response.…”

Nevirapine- Versus Lopinavir/Ritonavir-Based Antiretroviral Therapy in HIV-Infected Infants and Young Children: Long-term Follow-up of the IMPAACT P1060 Randomized Trial

“…Similarly, a better understanding of neurodevelopment is needed in the context of HIV infection and specific drug regimens [29]. McGrath et al found that infants on NVP-based ART demonstrated later speech attainment than those on LPV/r ART (18.1 vs 15.5 months; P = .003), although its long-term significance is yet unknown [30]. We are currently collecting longitudinal and neuropsychological assessment data among IMPAACT P1060 participants at several sites to address this gap.…”

Variability of Growth in Children Starting Antiretroviral Treatment in Southern Africa

“…Few studies have directly compared weight and height growth by calculating WHZ 24 or BMI 2,25-27 and data are therefore limited. Because children were underweight and stunted and catch-up growth in the first year of ART was particularly fast for WAZ, the degree of wasting was only moderate and normalized rapidly within 1 year.…”