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Mmbaga BT, Ngocho JS, Tierney C, Ziemba L, Reding C, Bone F, Bradford S, Costello D, Browning R, Moye J, Vhembo T, Mambiya S, Msowoya E, Owor M, Musoke P. Effects of Combination Antiretroviral Therapy and Nutritional Rehabilitation on Growth in Children Aged 6-36 Months with Severe Acute Malnutrition in IMPAACT Protocol P1092. J Pediatric Infect Dis Soc 2024; 13:387-395. [PMID: 38808862 DOI: 10.1093/jpids/piae053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 05/28/2024] [Indexed: 05/30/2024]
Abstract
BACKGROUND Antiretroviral therapy (ART) is known to improve child survival and growth in children living with HIV (CLHIV). We investigated growth outcomes in children with severe nonedematous acute malnutrition (SAM) and without SAM (mild malnutrition and normal nutrition) after initiation of ART in both groups and nutritional support. MATERIAL AND METHODS IMPAACT P1092 enrolled CLHIV aged 6 to <36 months with World Health Organization (WHO)-defined SAM or without SAM across 5 sites in Sub-Saharan Africa and followed them for 48 weeks. The enrollment was conducted in four countries: Malawi, Tanzania, Uganda, and Zimbabwe between October 2015 and September 2017. Weight, height, and mid-upper arm circumference (MUAC) were measured at baseline through 48 weeks. WHO weight-for-length/height Z-scores (WFL/H Z-score) were calculated. SAM children received readily available therapeutic food per WHO guidelines. All participants were initiated on a triple-ART regimen. SAM children entered the study after initial nutritional rehabilitation. RESULTS Fifty-two CLHIV, 25 in the SAM cohort and 27 in the without SAM cohort, were enrolled. WFL/H Z-scores and MUAC in the SAM cohort increased significantly at weeks 24 and 48 [WFL/H Z-scores: mean change (95% CI) 2.34 (1.77, 2.91) and 2.73 (2.09, 3.37), both P < .001; MUAC: mean change (95% CI) 2.63 (1.98, 3.28) and 3.53 (2.83, 4.24) cm, P < .001]. At week 48, mean SAM height was 4 cm shorter and mean weight 1 kg lighter than without SAM [post hoc mean differences -4.11 (95% CI -8.60, 0.38) cm and -0.92 (95% CI -2.22, 0.39) kg]. CONCLUSIONS CLHIV with SAM who undergo WHO nutritional rehabilitation can achieve significant growth and WFL/H Z-score improvements but continued intensive anthropometric monitoring is needed as SAM may still be behind those without SAM.
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Affiliation(s)
- Blandina Theophil Mmbaga
- Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical Centre Paediatric and Child health Department and Kilimanjaro Christian Medical University College, Faculty of Medicine, Moshi, Tanzania
| | - James Samwel Ngocho
- Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical Centre Paediatric and Child health Department and Kilimanjaro Christian Medical University College, Faculty of Medicine, Moshi, Tanzania
| | - Camlin Tierney
- Harvard T.H. Chan School of Public Health, Center for Biostatistics in AIDS research, Department of Biostatistics, Boston, Massachusetts, USA
| | - Lauren Ziemba
- Harvard T.H. Chan School of Public Health, Center for Biostatistics in AIDS research, Department of Biostatistics, Boston, Massachusetts, USA
| | | | | | | | - Diane Costello
- IMPAACT Laboratory Center, University of California, Los Angeles, California, USA
| | - Renee Browning
- National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, USA
| | - John Moye
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Maternal and Pediatric Infectious Disease Branch, Bethesda, Maryland, USA
| | - Tichaona Vhembo
- University of Zimbabwe Clinical Trials Research Centre, Harare, Zimbabwe
| | - Sharon Mambiya
- College of Medicine-Johns Hopkins Research Project, Blantyre, Malawi
| | - Esnath Msowoya
- University of North Carolina Project Malawi and Department of Obstetrics and Gynecology's Division of Global Women's Health, Chapel Hill, North Carolina, USA
| | - Maxensia Owor
- Makerere University Johns Hopkins University Research Collaboration and Department of Paediatrics and Child Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Philippa Musoke
- Makerere University Johns Hopkins University Research Collaboration and Department of Paediatrics and Child Health, College of Health Sciences, Makerere University, Kampala, Uganda
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Scholtz J, Ellis SM, Kruger HS. Weight gain in children from birth to 10 years on antiretroviral treatment. South Afr J HIV Med 2022; 23:1413. [DOI: 10.4102/sajhivmed.v23i1.1413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 09/16/2022] [Indexed: 11/05/2022] Open
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Chirindza N, Leach L, Mangona L, Nhaca G, Daca T, Prista A. Body composition, physical fitness and physical activity in Mozambican children and adolescents living with HIV. PLoS One 2022; 17:e0275963. [PMID: 36264880 PMCID: PMC9584386 DOI: 10.1371/journal.pone.0275963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 09/27/2022] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION As a result of the effectiveness of antiretroviral drugs (ART), HIV/AIDS has become a chronic disease, which has enabled children living with HIV to reach adolescence and adulthood. However, the long exposure to both the disease and ART has caused undesirable effects that compromise the physiological functioning and the quality of life of the subjects. OBJECTIVE To determine the body composition, physical fitness and habitual physical activity of children and adolescents living with HIV on ART. METHODS A total of 79 subjects of both genders aged 8-14 years, living with HIV in ART, selected by convenience participated in the study. The subjects underwent anthropometric assessment, physical fitness assessment and physical activity assessment. RESULTS Relative to reference norms, the values of the anthropometric indicators fell below 50th percentile (height/age = 92.4%; BMI/age 72.2%; sum of skinfolds = 51.9%; arm circumference = 63.3%). The prevalence of "low height/age" and "low weight/age" was 34.9% and 9.3%, respectively for boys, and 27.9% and 11.1%, respectively for girls. With the exception of trunk flexibility (12.3%), most subjects were considered unfit in the physical fitness tests (abdominal resistance = 76.4%; handgrip strength = 75.4%; lower limb power = 66.4%). The percentage of subjects with insufficient physical activity was 45.5% for boys and 77.8% for girls. The values for all variables were consistently and significantly lower when compared with studies done in Mozambicans boys and girls without HIV+ from both urban and rural areas. CONCLUSION The subjects participants in the study living with HIV and undergoing ART had impaired growth, low physical fitness and low levels of habitual physical activity in relation to the reference values of their peers without HIV, which compromised their physiological functioning and their quality of life.
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Affiliation(s)
- Nivaldo Chirindza
- Physical Activity and Health Research Group, FEFD, Universidade Pedagógica de Maputo, Maputo, Mozambique
- * E-mail: (AP); (NC)
| | - Lloyd Leach
- Department of Sport, Recreation and Exercise Science, University of the Western Cape, Cape Town, South Africa
| | - Lucília Mangona
- School of Sport Sciences, Universidade Eduardo Mondlane, Maputo, Mozambique
| | - Gomes Nhaca
- Physical Activity and Health Research Group, FEFD, Universidade Pedagógica de Maputo, Maputo, Mozambique
| | - Timóteo Daca
- Physical Activity and Health Research Group, FEFD, Universidade Pedagógica de Maputo, Maputo, Mozambique
| | - António Prista
- Physical Activity and Health Research Group, FEFD, Universidade Pedagógica de Maputo, Maputo, Mozambique
- * E-mail: (AP); (NC)
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Growth improvement following antiretroviral therapy initiation in children with perinatally-acquired HIV diagnosed in older childhood in Zimbabwe: a prospective cohort study. BMC Pediatr 2022; 22:446. [PMID: 35879693 PMCID: PMC9317209 DOI: 10.1186/s12887-022-03466-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 07/01/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Children who initiate antiretroviral therapy (ART) before age 5 years can recover height and weight compared to uninfected peers, but growth outcomes are unknown for children initiating ART at older ages. We investigated factors associated with growth failure at ART initiation and modelled growth by age on ART. METHODS We conducted secondary analysis of cohort of children aged 6-15 years late-diagnosed with HIV in Harare, Zimbabwe, with entry at ART initiation in 2013-2015. Factors associated with height-for-age (HAZ), weight-for-age (WAZ) and BMI-for-age (BAZ) z-scores <- 2 (stunting, underweight and wasting respectively) at ART initiation were assessed using multivariable logistic regression. These outcomes were compared at ART initiation and 12 month follow-up using paired t-tests. HAZ and BAZ were modelled using restricted cubic splines. RESULTS Participants (N = 302; 51.6% female; median age 11 years) were followed for a median of 16.6 months (IQR 11.0-19.8). At ART initiation 34.8% were stunted, 34.5% underweight and 15.1% wasted. Stunting was associated with age ≥ 12 years, CD4 count < 200 cells/μl, tuberculosis (TB) history and history of hospitalisation. Underweight was associated with older age, male sex and TB history, and wasting was associated with older age, TB history and hospitalisation. One year post-initiation, t-tests showed increased WAZ (p = 0.007) and BAZ (p = 0.004), but no evidence of changed HAZ (p = 0.85). Modelling showed that HAZ and BAZ decreased in early adolescence for boys on ART, but not girls. CONCLUSION Stunting and underweight were prevalent at ART initiation among late-diagnosed children, and HAZ did not improve after 1 year. Adolescent boys with perinatally acquired HIV and late diagnosis are particularly at risk of growth failure in puberty.
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Masi-Leone M, Arpadi S, Teasdale C, Yuengling KA, Mutiti A, Mogashoa M, Rivadeneira ED, Abrams EJ, Jao J. Growth and Metabolic Changes After Antiretroviral Initiation in South African Children. Pediatr Infect Dis J 2021; 40:1004-1010. [PMID: 34292268 PMCID: PMC10393083 DOI: 10.1097/inf.0000000000003258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Poor growth and metabolic disturbances remain concerns for children living with HIV (CLHIV). We describe the impact of viral load (VL) on growth and lipid outcomes in South African CLHIV <12 years initiating World Health Organization recommended first-line antiretroviral therapy (ART) from 2012 to 2015. METHODS Z scores for length-for-age (LAZ), weight-for-age (WAZ) and body mass index-for-age were calculated. Lipids (total cholesterol, low-density lipoprotein and high-density lipoprotein) were measured. Hemoglobin A1C ≥5.8 was defined as at risk for type 2 diabetes. Mixed effects models were used to assess the association of VL at ART initiation with Z scores and lipids over time. RESULTS Of 241 CLHIV, 151 (63%) were <3 years initiating LPV/r-based ART and 90 (37%) were ≥3 years initiating EFV-based ART. Among CLHIV <3 years, higher VL at ART initiation was associated with lower mean LAZ (ß: -0.30, P=0.03), WAZ (ß: -0.32, P=0.01) and low-density lipoprotein (ß: -6.45, P=0.03) over time. Among CLHIV ≥3, a log 10 increase in pretreatment VL was associated with lower mean LAZ (ß: -0.29, P=0.07) trending towards significance and lower WAZ (ß: -0.32, P=0.05) as well as with more rapid increases in LAZ (ß: 0.14 per year, P=0.01) and WAZ (ß: 0.19 per year, P=0.04). Thirty percent of CLHIV were at risk for type 2 diabetes at ART initiation. CONCLUSIONS CLHIV initiating ART <3 years exhibited positive gains in growth and lipids, though high viremia at ART initiation was associated with persistently low growth and lipids, underscoring the need for early diagnosis and rapid treatment initiation. Future studies assessing the long-term cardiometabolic impact of these findings are warranted.
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Affiliation(s)
- Michela Masi-Leone
- Master of Public Health Biostatistics Program, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Stephen Arpadi
- ICAP at Columbia University, Mailman School of Public Health, Columbia University, New York, NY
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
- Department of Pediatrics, Vagelos College of Physicians & Surgeons, Columbia University, New York, NY
| | - Chloe Teasdale
- ICAP at Columbia University, Mailman School of Public Health, Columbia University, New York, NY
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| | - Katharine A. Yuengling
- ICAP at Columbia University, Mailman School of Public Health, Columbia University, New York, NY
| | - Anthony Mutiti
- ICAP at Columbia University, Mailman School of Public Health, Columbia University, New York, NY
| | - Mary Mogashoa
- US Centers for Disease Control and Prevention, Pretoria, South Africa
| | | | - Elaine J. Abrams
- ICAP at Columbia University, Mailman School of Public Health, Columbia University, New York, NY
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
- Department of Pediatrics, Vagelos College of Physicians & Surgeons, Columbia University, New York, NY
| | - Jennifer Jao
- Northwestern University Feinberg School of Medicine, Chicago, IL
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Jarchi M, Bokharaei-Salim F, Esghaei M, Kiani SJ, Jahanbakhsh F, Monavari SH, Ataei-Pirkooh A, Marjani A, Keyvani H. The Frequency of HIV-1 Infection in Iranian Children and Determination of the Transmitted Drug Resistance in Treatment-Naïve Children. Curr HIV Res 2021; 17:397-407. [PMID: 31702525 DOI: 10.2174/1570162x17666191106111211] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 10/23/2019] [Accepted: 10/31/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND The advent of resistance-associated mutations in HIV-1 is a barrier to the success of the ARTs. OBJECTIVE In this study, the abundance of HIV-1 infection in Iranian children, and also detection of the TDR in naïve HIV-1 infected pediatric (under 12 years old) were evaluated. MATERIALS From June 2014 to January 2019, a total of 544 consecutive treatment-naïve HIV-1- infected individuals enrolled in this study. After RNA extraction, amplification, and sequencing of the HIV-1 pol gene, the DRM and phylogenetic analysis were successfully performed on the plasma specimens of the ART-naïve HIV-1-infected-children under 12 years old. The DRMs were recognized using the Stanford HIV Drug Resistance Database. RESULTS Out of the 544 evaluated treatment-naïve HIV-1-infected individuals, 15 (2.8%) cases were children under 12 years old. The phylogenetic analyses of the amplified region of pol gene indicated that all of the 15 HIV-1-infected pediatric patients were infected by CRF35_AD, and a total of 13.3% (2/15) of these children were infected with HIV-1 variants with SDRMs (one child harbored two related SDRMs [D67N, V179F], and another child had three related SDRMs [M184V, T215F, and K103N]), according to the last algorithm of the WHO. No PIs-related SDRMs were observed in HIV-1-infected children. CONCLUSION The current study demonstrated that a total of 13.3% of treatment-naïve HIV-1-infected Iranian pediatrics (under 12 years old) were infected with HIV-1 variants with SDRMs. Therefore, it seems that screening to recognize resistance-associated mutations before the initiation of ARTs among Iranian children is essential for favorable medication efficacy and dependable prognosis.
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Affiliation(s)
- Maryam Jarchi
- Department of Virology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Farah Bokharaei-Salim
- Department of Virology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Maryam Esghaei
- Department of Virology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Jalal Kiani
- Department of Virology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | | | | | - Angila Ataei-Pirkooh
- Department of Virology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Arezoo Marjani
- Department of Virology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Hossein Keyvani
- Department of Virology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
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Waalewijn H, Turkova A, Rakhmanina N, Cressey TR, Penazzato M, Colbers A, Burger DM. Optimizing Pediatric Dosing Recommendations and Treatment Management of Antiretroviral Drugs Using Therapeutic Drug Monitoring Data in Children Living With HIV. Ther Drug Monit 2019; 41:431-443. [PMID: 31008997 PMCID: PMC6636807 DOI: 10.1097/ftd.0000000000000637] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 03/03/2019] [Indexed: 12/27/2022]
Abstract
INTRODUCTION This review summarizes the current dosing recommendations for antiretroviral (ARV) drugs in the international pediatric guidelines of the World Health Organization (WHO), US Department of Health and Human Services (DHHS), and Pediatric European Network for Treatment of AIDS (PENTA), and evaluates the research that informed these approaches. We further explore the role of data generated through therapeutic drug monitoring in optimizing the dosing of ARVs in children. METHODS A PubMed search was conducted for the literature on ARV dosing published in English. In addition, the registration documentation of European Medicines Agency and the US Food and Drug Administration for currently used ARVs and studies referenced by the WHO, DHHS, and EMA guidelines were screened. Resulting publications were screened for papers containing data on the area under the concentration-time curve, trough concentration, and peak concentration. Studies with enrolled participants with a median or mean age of ≥18 years were excluded. No restriction on publishing date was applied. DISCUSSION AND CONCLUSION Pediatric ARV dosing is frequently based on data obtained from small studies and is often simplified to facilitate dosing in the context of a public health approach. Pharmacokinetic parameters of pediatric ARVs are subject to high interpatient variation and this leads to a potential risk of underdosing or overdosing when drugs are used in real life. To ensure optimal use of ARVs and validate dosing recommendations for children, it is essential to monitor ARV dosing more thoroughly with larger sample sizes and to include diverse subpopulations. Therapeutic drug monitoring data generated in children, where available and affordable, have the potential to enhance our understanding of the appropriateness of simplified pediatric dosing strategies recommended using a public health approach and to uncover suboptimal dosing or other unanticipated issues postmarketing, further facilitating the ultimate goal of optimizing pediatric ARV treatment.
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Affiliation(s)
- Hylke Waalewijn
- Department of Pharmacy, Radboud Institute for Health Sciences (RIHS), Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Anna Turkova
- MRC Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London
- Department of Paediatric Infectious Diseases, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Natella Rakhmanina
- Department of Pediatrics, School of Medicine and Health Sciences, The George Washington University
- Division of Infectious Diseases, Children's National Medical Center
- Elizabeth Glaser Pediatric AIDS Foundation, Washington, District of Columbia
| | - Tim R. Cressey
- PHPT/IRD UMI 174, Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
- Department of Immunology and Infectious Diseases, Harvard T.H Chan School of Public Health, Boston, Massachusetts
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, United Kingdom; and
| | - Martina Penazzato
- Treatment and Care, Department of HIV/AIDS, World Health Organization, Geneva, Switzerland
| | - Angela Colbers
- Department of Pharmacy, Radboud Institute for Health Sciences (RIHS), Radboud University Medical Centre, Nijmegen, the Netherlands
| | - David M. Burger
- Department of Pharmacy, Radboud Institute for Health Sciences (RIHS), Radboud University Medical Centre, Nijmegen, the Netherlands
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Anglemyer A, Sturt A, Maldonado Y. The Effect of Combination Antiretroviral Therapy Use Among HIV Positive Children on the Hazard of AIDS Using Calendar Year as an Instrumental Variable. Curr HIV Res 2019; 16:151-157. [PMID: 29629663 DOI: 10.2174/1570162x16666180409150826] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Revised: 03/25/2018] [Accepted: 04/03/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Instrumental variable (IV) analyses are a common causal inference technique used in the absence of randomized data. Combination Antiretroviral Therapy (cART) was first introduced in 1996 and calendar periods have been used as a proxy for cART use. However, cART use misclassification can bias IV analyses. OBJECTIVE We aim to highlight the differences in the effects of antiretroviral therapy on clinical outcomes between the applications of traditional and adapted IV analysis techniques. METHODS This study includes children with perinatal human immunodeficiency virus (HIV-1) infection followed from 1988 to 2009. We describe an application of traditional and adapted IV analysis techniques. Noncompliance adjustments were applied to correct the misclassification of cART-use. Weighting the inverse probability of calendar era, the selected covariates were performed to control for variables that may be related to both the IV and outcome. RESULTS During 48,380 person-days, 78 HIV-positive children progressed to an initial stage-3- defining diagnosis or death. The Intention to Treat (ITT) rate ratio (RR) of stage-3-defining diagnosis or death comparing the pre-cART and cART eras was estimated at 2·67 (95% confidence interval (CI): 1·.47, 4·84). The IV estimator was used to adjust for cART use misclassification, yielding an IV RR of 5·42 (95% CI: 2·99, 9·83). Weighting analyses did not markedly alter the results. CONCLUSION cART use decreased progression to stage-3-defining diagnosis or death. The use of noncompliance adjustments for cART misclassification in IV analyses may provide more robust evidence of cART's effectiveness than traditional ITT analysis.
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Affiliation(s)
- Andrew Anglemyer
- Operations Research Department, Naval Postgraduate School, Monterey, CA, United States
| | - Amy Sturt
- Pediatrics-Infectious Diseases, Stanford University, Stanford, CA, United States
| | - Yvonne Maldonado
- Pediatrics-Infectious Diseases, Stanford University, Stanford, CA, United States
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Golucci APBS, Marson FAL, Valente MFF, Branco MM, Prado CC, Nogueira RJN. Influence of AIDS antiretroviral therapy on the growth pattern. J Pediatr (Rio J) 2019; 95:7-17. [PMID: 29660296 DOI: 10.1016/j.jped.2018.02.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 02/23/2018] [Accepted: 12/07/2017] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES Human immunodeficiency virus infection can result in the early impairment of anthropometric indicators in children and adolescents. However, combined antiretroviral therapy has improved, in addition to the immune response and viral infection, the weight and height development in infected individuals. Therefore, the objective was to evaluate the effect of combined antiretroviral on the growth development of human immunodeficiency virus infected children and adolescents. SOURCE OF DATA A systematic review was performed. In the study, the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) strategy was used as the eligibility criterion. The MEDLINE-PubMed and LILACS databases were searched using these descriptors: HIV, children, growth, antiretroviral therapy. The objective was defined by the population, intervention, comparison/control, and outcome (PICO) technique. Inclusion and exclusion criteria were applied for study selection. SYNTHESIS OF DATA Of the 549 studies indexed in MEDLINE-PubMed and LILACS, 73 were read in full, and 44 were included in the review (33 showed a positive impact of combined antiretroviral therapy on weight/height development, ten on weight gain, and one on height gain in children and adolescents infected with human immunodeficiency virus). However, the increase in growth was not enough to normalize the height of infected children when compared to children of the same age and gender without human immunodeficiency virus infection. CONCLUSIONS Combined antiretroviral therapy, which is known to play a role in the improvement of viral and immunological markers, may influence in the weight and height development in children infected with human immunodeficiency virus. The earlier the infection diagnosis and, concomitantly, of malnutrition and the start of combined antiretroviral therapy, the lower the growth impairment when compared to healthy children.
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Affiliation(s)
| | - Fernando Augusto Lima Marson
- Universidade Estadual de Campinas (UNICAMP), Faculdade de Ciências Médicas, Departamento de Pediatria, Campinas, SP, Brazil; Universidade Estadual de Campinas (UNICAMP), Faculdade de Ciências Médicas, Departamento de Genética Médica, Campinas, SP, Brazil
| | | | - Maira Migliari Branco
- Universidade Estadual de Campinas (UNICAMP), Faculdade de Ciências Médicas, Hospital de Clínicas, Campinas, SP, Brazil
| | - Camila Carbone Prado
- Universidade Estadual de Campinas (UNICAMP), Faculdade de Ciências Médicas, Hospital de Clínicas, Campinas, SP, Brazil
| | - Roberto José Negrão Nogueira
- Universidade Estadual de Campinas (UNICAMP), Faculdade de Ciências Médicas, Departamento de Pediatria, Campinas, SP, Brazil; Faculdade São Leopoldo Mandic, Campinas, SP, Brazil.
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Influence of AIDS antiretroviral therapy on the growth pattern. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2019. [DOI: 10.1016/j.jpedp.2018.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Sharma TS, Somarriba G, Arheart KL, Neri D, Mathew MS, Graham PL, Scott GB, Miller TL. Longitudinal Changes in Body Composition by Dual-energy Radiograph Absorptiometry Among Perinatally HIV-infected and HIV-uninfected Youth: Increased Risk of Adiposity Among HIV-infected Female Youth. Pediatr Infect Dis J 2018; 37:1002-1007. [PMID: 29474262 PMCID: PMC6105572 DOI: 10.1097/inf.0000000000001963] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Combination antiretroviral therapy has allowed youth with perinatal HIV infection (PHIV+) to live into adulthood, but many youth may experience metabolic and body composition changes that predispose to greater cardiovascular disease (CVD) risk. This longitudinal study evaluated changes in body composition measured by dual-energy radiograph absorptiometry (DXA) in a cohort of PHIV+ youth compared with HIV- controls over a 7-year period. METHODS PHIV+ youth and HIV- controls were prospectively enrolled in a single-site study to assess nutrition and CVD risk. Anthropometrics and DXA scans were longitudinally obtained to assess percent body fat and regional fat distribution. Using general linear models, we analyzed differences in body composition and anthropometric measures by sex between PHIV+ youth and controls over time. RESULTS Two hundred thirty-five participants (156 PHIV+ and 79 HIV- controls) with at least 1 DXA performed since study enrollment were included for analysis. During the study period, 471 DXAs were obtained in the PHIV+ group and 95 in HIV- controls. PHIV+ females demonstrated greater increase in weight and body mass index over time compared with HIV- females, and significant increases in total percent body fat [estimate = 1.212 (95% confidence interval: 0.837-1.587) percent per year; P < 0.001) and percent trunk fat [1.3818 (95% confidence interval: 0.922-1.84); P < 0.001] compared with HIV- females and PHIV+ males. CONCLUSIONS PHIV+ females demonstrate an unfavorable change in fat redistribution and percent body fat over time that exceeds the pattern seen in PHIV+ males or HIV- females. Providers should have heightened awareness of body composition changes of PHIV+ females that may eventually lead to increased CVD risk.
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Affiliation(s)
- Tanvi S Sharma
- From the Division of Infectious Diseases, Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Gabriel Somarriba
- Department of Clinical Education, University of St. Augustine for Health Sciences, St. Augustine, Florida
| | - Kristopher L Arheart
- Division of Biostatistics, Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, Florida
| | - Daniela Neri
- Discipline of Nutrition, Department of Pediatrics, Paulista School of Medicine, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - M Sunil Mathew
- Division of Pediatric Clinical Research, Department of Pediatrics
| | | | - Gwendolyn B Scott
- Division of Pediatric Infectious Diseases and Immunology, Department of Pediatrics, Miller School of Medicine, University of Miami, Miami, Florida
| | - Tracie L Miller
- Division of Pediatric Clinical Research, Department of Pediatrics
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Thakur A, Qureshi A, Kumar M. vhfRNAi: a web-platform for analysis of host genes involved in viral infections discovered by genome wide RNAi screens. MOLECULAR BIOSYSTEMS 2018; 13:1377-1387. [PMID: 28561835 DOI: 10.1039/c6mb00841k] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Knockdown of host genes using high-throughput genome-wide RNA interference screens has identified numerous host factors that affect viral infections, which would be helpful in understanding host-virus interactions. We have developed a vhfRNAi web resource based on genome-wide RNAi experiments for viruses. It contains experimental details of 12 249 entries (host factors + restriction factors) for 18 viruses. Simultaneously, this resource encompasses analysis of overlapping genes, genome wide association studies, gene ontology (GO), pathogen interacting proteins, interaction networks and pathway enrichment. Using overlap analysis, it was found that Influenza A virus shared overlapping host genes with the majority of viruses including Hepatitis C virus and Dengue virus 2. In the genome wide association studies analysis, 429 diseases/traits were mapped, of which obesity-related traits were the most common. GO analysis revealed that the major categories belonged to metabolic processes, molecule transport, signal transduction, proteolysis, etc. In the pathogen interacting protein analysis, protein interaction data from different resources can be explored for further understanding of host-virus biology. By pathway enrichment analysis, a total of 8955 genes were mapped on 303 pathways with most of the hits coming from metabolic pathways. We have found 491 genes that are not essential for the host but essential for the virus and can be targeted to inhibit the virus. These may be explored as potential candidates for drug targets. The resource is freely accessible at and will be useful in understanding host-virus biology as well as identification of targets for the development of antiviral therapeutics.
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Affiliation(s)
- Anamika Thakur
- Bioinformatics Centre, Institute of Microbial Technology, Council of Scientific and Industrial Research, Sector 39-A, Chandigarh-160036, India.
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Aaradhana S, Ravi S, Vishnu M, Divya J, Kriti M. THE EFFECT OF NUTRITIONAL STATUS ON THE RESPONSE TO HIGHLY ACTIVE ANTIRETROVIRAL THERAPY IN HUMAN IMMUNODEFICIENCY VIRUS-INFECTED CHILDREN AT REGIONAL ANTIRETROVIRAL THERAPY CENTRE IN NORTHERN INDIA. INDIAN JOURNAL OF CHILD HEALTH 2018. [DOI: https://doi.org/10.32677/ijch.2018.v05.i02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Abstract
BACKGROUND Children living with HIV (CLHIV) commonly experience growth failure. We report growth parameters in CLHIV at baseline and during 3 years of antiretroviral therapy (ART). METHODS Records of CLHIV who had completed at least 3 years on ART were reviewed after excluding subjects who died, were lost to follow-up or developed treatment failure to assess impact of sustained administration of ART. Height-for-age (HFA) and body mass index for age (BFA) Z scores were calculated, and proportion of CLHIV with wasting and stunting estimated at baseline, 6, 12, 24 and 36 months after starting ART using the linear mixed model. Factors influencing significant changes in growth parameters were assessed. RESULTS HFA Z score improved steadily from -3.12 at baseline to -2.33 at 36 months of ART. The prevalence of stunting declined from 77.7% to 59.2% during this period. BFA Z scores improved from -1.2 at baseline to -0.4 at12 months on ART but declined to -1.0 at 36 months. The proportion of subjects with wasting was 29.3%, 9.7% and 16.7% at baseline, 12 and 36 months, respectively. Baseline clinical stage (1 + 2), absence of wasting and lower HFA Z score had significant positive influence on changes in HFA Z score, while younger age at ART initiation and a low baseline BFA Z score had a positive influence on catch-up in body mass index. Including data of children who died or developed treatment failure did not impact upon the results. CONCLUSION Majority of CLHIV are stunted at the start of ART. ART was only partially effective in countering malnutrition and growth failure in CLHIV.
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Growth Recovery Among HIV-infected Children Randomized to Lopinavir/Ritonavir or NNRTI-based Antiretroviral Therapy. Pediatr Infect Dis J 2016; 35:1329-1332. [PMID: 27580060 PMCID: PMC5106322 DOI: 10.1097/inf.0000000000001318] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Diminished growth is highly prevalent among HIV-infected children and might be improved by antiretroviral therapy (ART). We examined growth recovery in a rural Ugandan cohort of HIV-infected children randomized to lopinavir/ritonavir (LPV/r) or non nucleoside reverse transcription inhibitor-based ART. METHODS HIV-infected children 2 months to 6 years of age were randomized to LPV/r- or non nucleoside reverse transcription inhibitor-based ART. Changes in weight-for-age (WAZ), height-for-age (HAZ) and weight-for-height Z-scores for 24 months were evaluated using generalized linear repeated measures models. Recovery from being underweight (WAZ<-2), stunted (HAZ<-2) and wasted (weight-for-height <-2) to Z-scores greater than -2 was also compared by arm using Kaplan-Meier survival and Cox proportional hazard modeling. RESULTS A total of 129 children with median age of 3 years initiated therapy; 64 received LPV/r-based and 65 non nucleoside reverse transcription inhibitor-based ART (nevirapine: 36 and efavirenz: 29). The median (interquartile range) difference in growth measures between baseline and 24 months for LPV/r (n = 45) versus non nucleoside reverse transcription inhibitor-based therapy (n = 40) were as follows: WAZ, 0.47 (0.10, 1.62) versus 0.53 (0.03, 1.14) (P = 0.59) and HAZ, median 1.55 (0.78, 1.86) versus 1.19 (0.62, 1.65) (P = 0.23), respectively. ART regimen was not predictive of change in WAZ (β: -0.02, 95% confidence interval: -0.25, 0.20) or HAZ (β: 0.05, 95% confidence interval: -0.10, 0.19). The presence of confirmed virologic failure was not associated with growth. CONCLUSIONS Most ART-naive children experienced recovery of both WAZ and HAZ over the 24 months after ART initiation, with no significant difference between those receiving LPV/r versus non nucleoside reverse transcriptase inhibitor-based ART. However, the persistence of median Z-scores below 0 underscores the need for additional strategies to improve growth outcomes in HIV+ African children.
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Feucht UD, Van Bruwaene L, Becker PJ, Kruger M. Growth in HIV-infected children on long-term antiretroviral therapy. Trop Med Int Health 2016; 21:619-29. [PMID: 26914715 DOI: 10.1111/tmi.12685] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To describe growth in HIV-infected children on long-term antiretroviral therapy (ART) and to assess social, clinical, immunological and virological factors associated with suboptimal growth. METHODS This observational cohort study included all HIV-infected children at an urban ART site in South Africa who were younger than 5 years at ART initiation and with more than 5 years of follow-up. Growth was assessed using weight-for-age Z-scores (WAZ), height-for-age Z-scores (HAZ) and body mass index (BMI)-for-age Z-scores (BAZ). Children were stratified according to pre-treatment anthropometry and age. Univariate and mixed linear analysis were used to determine associations between independent variables and weight and height outcomes. RESULTS The majority of the 159 children presented with advanced clinical disease (90%) and immunosuppression (89%). Before treatment underweight, stunting and wasting were common (WAZ<-2 = 50%, HAZ<-2 = 73%, BAZ<-2 = 19%). Weight and BMI improved during the initial 12 months, while height improved over the entire 5-year period. Height at study exit was significantly worse for children with growth impairment at ART initiation (P < 0.001), and infants (<1 year) demonstrated superior improvement in terms of BMI (P = 0.04). Tuberculosis was an independent risk factor for suboptimal weight (P = 0.01) and height (P = 0.02) improvement. Weight gain was also hindered by lack of electricity (P = 0.04). Immune reconstitution and virological suppression were not associated with being underweight or stunted at study endpoint. CONCLUSIONS Malnutrition was a major clinical concern for this cohort of HIV-infected children. Early ART initiation, tuberculosis co-infection management and nutritional interventions are crucial to ensure optimal growth in HIV-infected children.
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Affiliation(s)
- Ute D Feucht
- Department of Paediatrics, Kalafong Hospital, University of Pretoria, Pretoria, South Africa
| | - Lore Van Bruwaene
- Department of Paediatrics, Kalafong Hospital, University of Pretoria, Pretoria, South Africa.,University Hospital Gasthuisberg, Leuven, Belgium
| | - Piet J Becker
- Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Mariana Kruger
- Department of Paediatrics and Child Health, University of Stellenbosch, Tygerberg, South Africa
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Ebissa G, Deyessa N, Biadgilign S. Impact of highly active antiretroviral therapy on nutritional and immunologic status in HIV-infected children in the low-income country of Ethiopia. Nutrition 2015; 32:667-73. [PMID: 26875999 DOI: 10.1016/j.nut.2015.12.035] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2014] [Revised: 11/20/2015] [Accepted: 12/14/2015] [Indexed: 02/04/2023]
Abstract
OBJECTIVE HIV/AIDS and malnutrition combine to undermine the immunity of individuals and are inextricably interrelated. Although the effect of highly active antiretroviral therapy (HAART) on growth in HIV-infected children is well known, the influence of prior nutritional and immunologic status on the response to HAART is not well documented. The aim of the present study was to determine the effects of HAART on nutritional and immunological status in HIV-infected children in the low-income country of Ethiopia. METHODS A multicenter, retrospective cohort study was conducted on HIV-infected children receiving antiretroviral therapy at the pediatric units of public hospitals in Addis Ababa (Black Lion, Zewditu, Yekatit 12 and ALERT hospitals), Ethiopia. Nutritional status was defined as stunting (height-for-age Z score [HAZ] <-2), wasting (weight-for-height Z score [WHZ] <-2), and underweight (weight-for-age Z score [WAZ] <-2). Multivariable logistic regression was used to analyze factors associated with treatment success and to establish whether growth (baseline nutritional status) in children predicts immunologic outcomes. In all, 556 HIV-infected children receiving HAART from January 2008 to December 2009 were included in this study. RESULTS Over the 24-mo follow-up period, the study showed that the immunologic recovery of stunted and underweight children, regardless of their baseline nutritional status, responded equally to treatment. However, wasted children showed less immunologic recovery at the different follow-up visits. Predictors of positive shift in WHZ after 24 mo of follow-up were advanced disease stage (World Health Organization clinical stages 3 and 4) with odds ratio (OR), 0.25 (95% confidence interval [CI], 0.34-0.99; P = 0.045) and baseline severe underweight OR, 0.19 (95% CI, 0.09-0.56; P = 0.003). The independent predictors of positive shift of growth shift in WAZ over 24 mo were lower baseline age (<36 mo) with OR, 0.21 (95% CI, 0.04-0.90; P = 0.036) and baseline moderate underweight itself with OR, 0.11 (95% CI, 0.05-0.25; P = 0.0001) were predictors of positive shift (shift to normal). CONCLUSION Despite the apparent growth response in HIV-infected children after initiation of HAART, moderate and severe underweight are both independent predictors of a positive shift. The latter suggests that children on HAART require nutritional supplementation, especially during the early initiation of HAART.
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Affiliation(s)
- Getachew Ebissa
- Department of General Public Health, College of Health Sciences, Haramaya University, Harar, Ethiopia
| | - Negusse Deyessa
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
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Growth in Virologically Suppressed HIV-Positive Children on Antiretroviral Therapy: Individual and Population-level References. Pediatr Infect Dis J 2015; 34:e254-9. [PMID: 26192393 PMCID: PMC4570854 DOI: 10.1097/inf.0000000000000801] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Combination antiretroviral therapy (ART) suppresses viral replication in HIV-infected children. The growth of virologically suppressed children on ART has not been well documented. We aimed to develop dynamic reference curves for weight-for-age Z scores (WAZ) and height-for-age Z scores (HAZ). METHODS Children aged <11 years at ART initiation with continuously undetectable viral loads (<400 copies/mL) treated at 7 South African ART programs with routine viral load monitoring were included. We used multilevel models to define trajectories of WAZ and HAZ up to 3 years and developed a web application to monitor trajectories in individual children. RESULTS A total of 4876 children were followed for 7407 person-years. Analyses were stratified by baseline Z scores and age, which were the most important predictors of growth response. The youngest children showed the most pronounced increase in weight and height initially but catch-up growth stagnated after 1-2 years. Three years after starting ART, WAZ ranged from -2.2 [95% prediction interval (PrI), -5.6 to 0.8] in children with baseline age >5 years and Z score less than -3 to 0.0 (95% PrI, -2.7 to 2.4) in children with baseline age <2 years and WAZ greater than -1. For HAZ, the corresponding range was -2.3 (95% PrI, -4.9 to 0.3) in children with baseline age >5 years and Z score less than -3 to 0.3 (95% PrI, -3.1 to 3.4) in children with baseline age 2-5 years and HAZ greater than -1. CONCLUSIONS We have developed an online tool to calculate reference trajectories in fully suppressed children. The web application could help to define "optimal" growth response and identify children with treatment failure.
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McGrath CJ, Diener L, Richardson BA, Peacock-Chambers E, John-Stewart GC. Growth reconstitution following antiretroviral therapy and nutritional supplementation: systematic review and meta-analysis. AIDS 2015; 29:2009-23. [PMID: 26355573 PMCID: PMC4579534 DOI: 10.1097/qad.0000000000000783] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE As antiretroviral therapy (ART) expands for HIV-infected children, it is important to determine its impact on growth. We quantified growth and its determinants following ART in resource-limited (RLS) and developed settings. DESIGN Systematic review and meta-analysis. METHODS We searched publications reporting growth [weight-for-age (WAZ), height-for-age (HAZ), and weight-for-height (WHZ) z scores] in HIV-infected children following ART through August 2014. Inclusion criteria were as follows: younger than 18 years; ART; at least 20 patients; growth at ART; and post-ART growth. Standardized and overall weighted mean differences were calculated using random-effects models. RESULTS A total of 67 articles were eligible (RLS = 54; developed settings = 13). Mean age was 5.8 years, and comparable between settings (P = 0.90). Baseline growth was substantially lower in RLS vs. developed settings (WAZ -2.1 vs. -0.5; HAZ -2.2 vs. -0.9; both P < 0.01). Rate of weight but not height reconstitution during 12 and 24 months was higher in RLS (12-month WAZ change 0.84 vs. 0.17, P < 0.01). Growth deficits persisted in RLS after 2 years ART (P = 0.04). Younger cohort age was associated with greater growth reconstitution. Protease inhibitor and nonnucleoside reverse-transcriptase inhibitor regimens yielded comparable growth. Adjusting for age and setting, cohorts with nutritional supplements had greater growth gains (24-month rate difference: WAZ 0.55, P = 0.03; HAZ 0.60, P = 0.007). Supplement benefits were attenuated after adjusting for baseline cohort growth. CONCLUSION RLS children had substantial growth deficits compared with developed settings counterparts at ART; growth shortfalls in RLS persisted despite reconstitution. Earlier age and nutritional supplementation at ART may improve growth outcomes. Scant data on supplementation limit evaluation of impact and underscores need for systematic data collection regarding supplementation in pediatric ART programmes/cohorts.
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Affiliation(s)
- Christine J McGrath
- aDepartment of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas bDepartment of Global Health cDepartment of Biostatistics dDivision of Vaccine and Infectious Diseases, Fred Hutchinson Cancer Research Center, Seattle, Washington eDepartment of Pediatrics, Boston Medical Center, Boston, Massachusetts fDepartment of Medicine gDepartment of Pediatrics hDepartment of Epidemiology, University of Washington, Seattle, Washington, USA
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Teklemariam Z, Mitiku H, Mesfin F. Prevalence of anemia and nutritional status among HIV-positive children receiving antiretroviral therapy in Harar, eastern Ethiopa. HIV AIDS (Auckl) 2015; 7:191-6. [PMID: 26089702 PMCID: PMC4467660 DOI: 10.2147/hiv.s78845] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Anemia and growth retardation are common manifestations of HIV-positive children, which threaten their lives. Therefore, this study tried to assess the burden of anemia and the nutritional status of HIV-positive children receiving antiretroviral therapy (ART) in eastern Ethiopa. PATIENTS AND METHODS A total of 108 records of children on ART followed up in Hiwot Fana Specialized University Hospital from 2007 to 2010 were retrospectively reviewed from November 1 to November 30, 2011. RESULTS Approximately 54.4% of the children had been anemic before the initiation of their ART (at baseline): 7.8% were severely anemic and 44.7% were moderately anemic. These percentages were higher in preschool children than in school children (adjusted odds ratio [AOR]: 4.80 [95% confidence interval {CI}: 1.96, 11.75]), and were higher in males than in females (AOR: 2.61 [95% CI: 1.06, 6.45]). The prevalence of anemia was reduced to 39.2% 1 year after initiation of ART. The increasing of hemoglobin values was highly significant for both zidovudine (AZT)- and stavudine (d4T)-based ART (P<0.05). At baseline, 51.6% of the study subjects were underweight (weight-for-age Z score less than -2 standard deviation [SD]); 49.1% were stunted (height-for-age Z score less than -2 SD); and 31.5% were wasted (body mass index less than -2 SD), which, after a year on ART, declined to 8.9%, 15.9%, and 9.8%, respectively. CONCLUSION There was high prevalence of anemia and growth failure among HIV-infected children in the study area. However, there was a decline after initiation of ART. Therefore, adherence counseling to strengthen the uptake of ART is recommended. Moreover, large-scale, prospective studies should be done to understand the magnitude and etiology of the problems with HIV-negative control groups.
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Affiliation(s)
- Zelalem Teklemariam
- Department of Medical Laboratory Sciences, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Habtamu Mitiku
- Department of Medical Laboratory Sciences, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Firehiwot Mesfin
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Parchure RS, Kulkarni VV, Darak TS, Mhaskar R, Miladinovic B, Emmanuel PJ. Growth Patterns of HIV Infected Indian Children in Response to ART: A Clinic Based Cohort Study. Indian J Pediatr 2015; 82:519-24. [PMID: 25575909 DOI: 10.1007/s12098-014-1659-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 12/04/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To describe catch-up growth after antiretroviral therapy (ART) initiation among children living with human immunodeficiency virus (CLHIV), attending a private clinic in India. METHODS This is a retrospective analysis of data of CLHIV attending Prayas clinic, Pune, India. Height and weight z scores (HAZ, WAZ) were calculated using WHO growth charts. Catch-up growth post-ART was assessed using a mixed method model in cases where baseline and at least one subsequent follow-up HAZ/WAZ were available. STATA 12 was used for statistical analysis. RESULTS During 1998 to 2011, 466 children were enrolled (201 girls and 265 boys; median age = 7 y). A total of 302 children were ever started on ART; of which 73 and 76 children were included for analysis for catch up growth in WAZ and HAZ respectively. Median WAZ and HAZ increased from -2.14 to -1.34 (p = 0.007) and -2.42 to -1.94 (p = 0.34), respectively, 3 y post ART. Multivariable analysis using mixed model (adjusted for gender, guardianship, baseline age, baseline WAZ/HAZ, baseline and time varying WHO clinical stage) showed gains in WAZ (coef = 0.2, 95 % CI: -0.06 to 0.46) and HAZ (coef = 0.49, 95 % CI: 0.21 to 0.77) with time on ART. Lower baseline WAZ/HAZ and older age were associated with impaired catch-up growth. Children staying in institutions and with baseline advanced clinical stage showed higher gain in WAZ. CONCLUSIONS The prevalence of stunting and underweight was high at ART initiation. Sustained catch-up growth was seen with ART. The study highlights the benefit of early ART in achieving normal growth in CLHIV.
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Affiliation(s)
- Ritu S Parchure
- Prayas, Karve Road Corner, Deccan Gymkhana, Pune, 411004, India,
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Safety and efficacy of darunavir/ritonavir in treatment-experienced pediatric patients: week 48 results of the ARIEL trial. Pediatr Infect Dis J 2015; 34:e132-7. [PMID: 25719453 DOI: 10.1097/inf.0000000000000644] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND ARIEL (Darunavir in treatment-experienced pediatric population) was a phase II, open-label study assessing safety and antiviral activity of darunavir/ritonavir twice daily with an optimized background regimen (OBR) in treatment-experienced, HIV-1-infected pediatric patients (3 to <6 years, weighing 10 to <20 kg). METHODS The study consisted of an initial 4-week screening period, 48 weeks of treatment and a 4-week follow-up period. Patients initially received darunavir/ritonavir 20/3 mg/kg twice-daily for 2 weeks. Following review of pharmacokinetic, safety and antiviral data, the doses of darunavir/ritonavir were adjusted to 25/3 mg/kg twice-daily for patients <15 kg, and 375/50 mg twice-daily for patients 15 to <20 kg. RESULTS Of the 34 patients screened, 21 were treated (median treatment duration 48.6 weeks). Darunavir plus an OBR was well tolerated over 48 weeks, with no new safety concerns, and a comparable safety profile to that seen in older children and adults. All treatment-emergent lipid-related and glucose-related laboratory abnormalities were grade 1 or 2. At week 48, 17 of 21 patients (81.0%) had a confirmed virologic response (intent-to-treat, time-to-loss of virologic response). Improvements in height and weight were seen during the study. CONCLUSIONS No new safety concerns were observed over a 48 week period. These results led to lowering the age to 3 years at which darunavir/ritonavir is indicated for use in treatment-experienced pediatric patients. This study also established doses of darunavir to use in treatment-experienced, HIV-1-infected patients aged 3 to <6 years. A high virologic response was observed with this dose. No development of resistance was observed in patients who experienced virologic failure.
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Conundrum of growth and childhood HIV infection. J Pediatr Gastroenterol Nutr 2014; 59:424-5. [PMID: 24979480 DOI: 10.1097/mpg.0000000000000476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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Arbeitman LE, O’Brien RC, Somarriba G, Messiah SE, Neri D, Scott GB, Miller TL. Body mass index and waist circumference of HIV-infected youth in a Miami cohort: comparison to local and national cohorts. J Pediatr Gastroenterol Nutr 2014; 59:449-54. [PMID: 24709829 PMCID: PMC4524541 DOI: 10.1097/mpg.0000000000000394] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVES Human immunodeficiency virus (HIV)-infected youth are healthier because of effective antiretroviral therapies. We compared anthropometric measurements and prevalence of overweight and obesity between perinatally HIV-infected youth, a local HIV-uninfected comparison group, and 2007 to 2010 National Health and Nutrition Examination Survey (NHANES) data. In addition, we compared only African American HIV-infected youth with NHANES African Americans. METHODS Height, weight, body mass index (BMI), and waist circumference (WC) of HIV-infected youth, aged 10 to 19 years, were compared among groups. BMI percentiles were categorized as underweight (<5%), normal (5% to <85%), overweight (85% to <95%), and obese (≥ 95%). Clinical correlates were modeled as predictors of BMI and WC. RESULTS A total of 134 HIV-infected (including 103 African Americans) (mean age 16.5 years), 75 HIV-uninfected (mean age 14.2 years), and 3216 NHANES (including 771 NHANES African Americans) (mean age 15.0 years) youth were included in the analysis. Height and weight z scores of HIV-infected youth were lower than those of HIV-uninfected and NHANES (P ≤ 0.056) youth. BMI, WC, and BMI category were not statistically different between groups. In the HIV-infected African American group, BMI z score was lower (0.49 vs 0.76, P = 0.04) compared with NHANES African Americans. There were no significant predictors of BMI or WC for the HIV-infected group. CONCLUSIONS HIV-infected children have similar BMIs and WCs as uninfected children both locally and nationally and show similar high rates of obesity and overweight. When compared with a more racially similar African American national sample, HIV-infected children have a lower BMI, suggesting that there may be persistent anthropometric differences in HIV.
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Affiliation(s)
- Lori E. Arbeitman
- Division of Pediatric Clinical Research, Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL, United States
- Holtz Children’s Hospital/Jackson Memorial Hospital, Miami, FL, United States
| | - Robert C. O’Brien
- Division of Pediatric Clinical Research, Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Gabriel Somarriba
- Division of Pediatric Clinical Research, Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Sarah E. Messiah
- Division of Pediatric Clinical Research, Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Daniela Neri
- Division of Pediatric Clinical Research, Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL, United States
- Infectious Disease, Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Gwendolyn B. Scott
- Infectious Disease, Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Tracie L. Miller
- Division of Pediatric Clinical Research, Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL, United States
- Holtz Children’s Hospital/Jackson Memorial Hospital, Miami, FL, United States
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Loomba-Albrecht LA, Bregman T, Chantry CJ. Endocrinopathies in children infected with human immunodeficiency virus. Endocrinol Metab Clin North Am 2014; 43:807-28. [PMID: 25169569 DOI: 10.1016/j.ecl.2014.06.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Endocrine changes (including adrenal insufficiency, disorders of growth and puberty, thyroid dysfunction, metabolic abnormalities and osteopenia) accompany human immunodeficiency virus (HIV) infection in pediatric patients. The cause of these changes is multifactorial and includes direct viral effects of HIV, and effects of antiretroviral therapy. These effects may be of particular importance in childhood given the critical developmental processes that occur during this time period and the likelihood of prolonged exposure to the virus and medications.
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Affiliation(s)
- Lindsey A Loomba-Albrecht
- Section of Endocrinology, Department of Pediatrics, University of California Davis Medical Center, 2516 Stockton Boulevard, Suite 384, Sacramento, CA 95817-2208, USA.
| | - Thea Bregman
- Department of Pediatrics, University of California Davis Medical Center, 2516 Stockton Boulevard, Suite 216, Sacramento, CA 95817, USA
| | - Caroline J Chantry
- Department of Pediatrics, University of California Davis Medical Center, 2516 Stockton Boulevard, Suite 334, Sacramento, CA 95817-2208, USA
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Mwiru RS, Spiegelman D, Duggan C, Seage GR, Semu H, Chalamilla G, Kisenge R, Fawzi WW. Growth among HIV-infected children receiving antiretroviral therapy in Dar es Salaam, Tanzania. J Trop Pediatr 2014; 60:179-88. [PMID: 24393831 PMCID: PMC4040821 DOI: 10.1093/tropej/fmt104] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We assembled a prospective cohort of 3144 human immunodeficiency virus (HIV) infected children aged <15 years initiating antiretroviral therapy (ART) in Dar es Salaam, Tanzania. The prospective relationships of baseline covariates with growth were examined using linear regression models. ART led to improvement in mean weight-for-age (WAZ), height/length-for-age (HAZ) and weight-for-length or body mass index (WLZ/BMIZ) scores. However, normal HAZ values were not attained over an average follow-up of 17.2 months. After 6 months of ART, underweight (P < 0.001), low CD4 count or percent (P < 0.001), stavudine containing regimens (P = 0.05) and advanced WHO disease stage (P < 0.001) at ART initiation were associated with better WAZ scores. Age >5 years on the other hand was associated with less increase in WAZ score after 6 months of ART (P < 0.001). These findings suggest that although ART improved the growth of the HIV-infected children in Tanzania, adjunct nutritional interventions may be needed to ensure that the growth of these children is optimized to the greatest extent possible.
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Affiliation(s)
| | - Donna Spiegelman
- Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts 02115, USA,Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts 02115, USA
| | - Christopher Duggan
- Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts 02115, USA,Center for Nutrition, Division of GI/Nutrition, Boston Children’s Hospital, Boston, Massachusetts 02115, USA
| | - George R. Seage
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts 02115, USA
| | - Helen Semu
- Ministry of Health and Social Welfare, Dar es Salaam, Tanzania
| | - Guerino Chalamilla
- Management and Development for Health (MDH), Dar es Salaam, Tanzania,Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts 02115, USA
| | - Rodrick Kisenge
- Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Wafaie W. Fawzi
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts 02115, USA,Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts 02115, USA,Department of Global Health and Population, Harvard School of Public Health, Boston, Massachusetts 02115, USA
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Shiau S, Kuhn L. Antiretroviral treatment in HIV-infected infants and young children: novel issues raised by the Mississippi baby. Expert Rev Anti Infect Ther 2014; 12:307-18. [PMID: 24506199 DOI: 10.1586/14787210.2014.888311] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The recent case report of an HIV-infected child in Mississippi with viral control post-antiretroviral therapy (ART) interruption has sparked interest in the possibility of 'functional cure' in infants if they initiate ART very soon after birth. The 'Mississippi baby' also raises many new questions around the clinical care of HIV-infected infants and young children, including when treatment should be initiated, why treatment should be initiated, what treatment should be initiated, and how to identify infants early enough to treat them adequately. Here, we review research conducted before the report of the 'Mississippi baby' highlighting the important new issues that now need to be taken into consideration.
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Affiliation(s)
- Stephanie Shiau
- Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA
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28
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Williams PL, Abzug MJ, Jacobson DL, Wang J, Van Dyke RB, Hazra R, Patel K, Dimeglio LA, McFarland EJ, Silio M, Borkowsky W, Seage GR, Oleske JM, Geffner ME. Pubertal onset in children with perinatal HIV infection in the era of combination antiretroviral treatment. AIDS 2013; 27:1959-70. [PMID: 24145244 PMCID: PMC4143250 DOI: 10.1097/qad.0b013e328361195b] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To evaluate associations of perinatal HIV infection, HIV disease severity, and combination antiretroviral treatment with age at pubertal onset. DESIGN Analysis of data from two US longitudinal cohort studies (IMPAACT 219C and PHACS AMP), conducted during 2000-2012, including perinatally HIV-infected (PHIV) and HIV-exposed but uninfected (HEU) youth. Tanner stage assessments of pubertal status (breast and pubic hair in girls; genitalia and pubic hair in boys) were conducted annually. METHODS We compared the timing of pubertal onset (Tanner stage ≥2) between PHIV and HEU youth using interval-censored models. For PHIV youth, we evaluated associations of HIV disease severity and combination antiretroviral treatment with age at pubertal onset, adjusting for race/ethnicity and birth cohort. RESULTS The mean age at pubertal onset was significantly later for the 2086 PHIV youth compared to the 453 HEU children (10.3 vs. 9.6, 10.5 vs. 10.0, 11.3 vs. 10.4, and 11.5 vs. 10.7 years according to female breast, female pubic hair, male genitalia, and male pubic hair staging, respectively, all P < 0.001). PHIV youth with HIV-1 RNA viral load above 10, 000 copies/ml (vs. ≤10, 000 copies/ml) or CD4% below 15% (vs. ≥15%) had significantly later pubertal onset (by 4-13 months). Each additional year of combination antiretroviral treatment was associated with a 0.6-1.2-month earlier mean age at pubertal onset, but this trend did not persist after adjustment for birth cohort. CONCLUSION Pubertal onset occurs significantly later in PHIV than in HEU youth, especially among those with more severe HIV disease. However, in the current era, combination antiretroviral treatment may result in more normal timing of pubertal onset.
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Affiliation(s)
- Paige L Williams
- aCenter for Biostatistics in AIDS Research bDepartment of Biostatistics, Harvard School of Public Health, Boston, Massachusetts cDepartment of Pediatrics (Infectious Diseases), University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado dTulane University School of Medicine, New Orleans, Louisiana eEunice Kennedy Shriver National Institute of Child Health & Human Development, Bethesda, Maryland fDepartment of Epidemiology, Harvard School of Public Health, Boston, Massachusetts gSection of Pediatric Endocrinology, Indiana University School of Medicine, Indianapolis, Indiana hDepartment of Pediatrics, University of Colorado School of Medicine, Denver, Colorado iNew York University School of Medicine, New York jDepartment of Pediatrics, New Jersey Medical School, Newark, New Jersey kSaban Research Institute, Children's Hospital Los Angeles, Los Angeles, California, USA
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Shiau S, Arpadi S, Strehlau R, Martens L, Patel F, Coovadia A, Abrams EJ, Kuhn L. Initiation of antiretroviral therapy before 6 months of age is associated with faster growth recovery in South African children perinatally infected with human immunodeficiency virus. J Pediatr 2013; 162:1138-45, 1145.e1-2. [PMID: 23312691 PMCID: PMC3640753 DOI: 10.1016/j.jpeds.2012.11.025] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2012] [Revised: 10/10/2012] [Accepted: 11/09/2012] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To describe the effects of age at antiretroviral therapy (ART) initiation on growth outcomes among children infected with HIV followed for 48 months after treatment initiation. STUDY DESIGN This secondary analysis describes anthropometric changes in children infected with HIV in Johannesburg, South Africa who initiated ritonavir-boosted lopinavir-based ART before 24 months of age and were randomized to continue ritonavir-boosted lopinavir or to receive nevirapine after achieving and maintaining virologic suppression. Weight, height, and head circumference were measured at visits over 48 months post-ART initiation. Growth patterns including weight-for-age z-scores (WAZs), height-for-age z-scores, body mass index-for-age z-scores, and head circumference for age z-score were compared between children initiating ART<6 months, 6-12 months, and 12-24 months of age. RESULTS A total of 195 children (mean±SD age 10.7±5.9 months), including 54 (27.7%)<6 months, 69 (35.4%) 6-12 months, and 72 (36.9%) 12-24 months of age at ART initiation, were evaluated. In the first 12 months on treatment, children<6 months of age at ART initiation experienced more rapid improvement in WAZ (1.98 vs 1.44, P=.084) and head circumference for age z-score (1.24 vs 0.45, P=.004) than children who initiated ART between 12-24 months of age. By 48 months on ART, growth outcomes were similar, regardless of age at ART initiation. WAZ approached population norms by 12 months on ART. Although improving, height-for-age z-scores remained on average 1.0 z-score below population norms at 48 months of therapy. CONCLUSIONS Initiation of ART before 6 months of age results in more rapid growth recovery in children infected with HIV. These data provide further evidence for the importance of prompt diagnosis and early initiation of ART for infants infected with HIV.
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Affiliation(s)
- Stephanie Shiau
- Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, NY
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| | - Stephen Arpadi
- Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, NY
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| | - Renate Strehlau
- Faculty of Health Sciences, University of the Witwatersrand, Rahima Moosa Mother and Child Hospital, Johannesburg, South Africa
| | - Leigh Martens
- Faculty of Health Sciences, University of the Witwatersrand, Rahima Moosa Mother and Child Hospital, Johannesburg, South Africa
| | - Faeezah Patel
- Faculty of Health Sciences, University of the Witwatersrand, Rahima Moosa Mother and Child Hospital, Johannesburg, South Africa
| | - Ashraf Coovadia
- Faculty of Health Sciences, University of the Witwatersrand, Rahima Moosa Mother and Child Hospital, Johannesburg, South Africa
| | - Elaine J. Abrams
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| | - Louise Kuhn
- Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, NY
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
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Abstract
Aberrations in GHRH-GH -IGF-I axis are common in the complex of HIV, HAART and AIDS. There are 2 distinct mechanisms at play in HIV and AIDS. One is primarly associated with development of lipodystrophy and results in complications such as chronic inflammation, insulin resistance, lipid and metabolic abnormalities. HIV lipodystrophy is found especially in those on highly active anti-retroviral therapy (HAART). The various processes involved in lipodystrophy result in the suppression of pituitary GH production. The mechanism of low GH levels relates to increased somatostatin tone, decreased Ghrelin, increased free fatty acids (FFA) and insulin resistance. On the other hand in AIDS wasting syndrome; elevated GH and low IGF-1 levels are seen suggesting GH resistance. The GHRH analog-Tesamorelin is the only treatment option, which is FDA approved for use in reduction of excess abdominal fat in patients with HIV-associated lipodystrophy. Although long-term clinical trials and experience is needed to further study the benefits and risks of Tesamorelin.
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Affiliation(s)
- Shobhit Jain
- Department of Pediatrics, SUNY Downstate Medical Center & Kings County Hospital Center, Brooklyn, NY 11203, USA
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Ram M, Gupte N, Nayak U, Kinikar AA, Khandave M, Shankar AV, Sastry J, Bollinger RC, Gupta A. Growth patterns among HIV-exposed infants receiving nevirapine prophylaxis in Pune, India. BMC Infect Dis 2012; 12:282. [PMID: 23114104 PMCID: PMC3556061 DOI: 10.1186/1471-2334-12-282] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Accepted: 10/26/2012] [Indexed: 11/10/2022] Open
Abstract
Background India has among the highest rates of infant malnutrition. Few studies investigating the growth patterns of HIV-exposed infants in India or the impact of timing of HIV infection on growth in settings such as India exist. Methods We used data from the Six Week Extended Nevirapine (SWEN) trial to compare the growth patterns of HIV-infected and HIV-exposed but uninfected infants accounting for timing of HIV infection, and to identify risk factors for stunting, underweight and wasting. Growth and timing of HIV infection were assessed at weeks 1, 2, 4, 6, 10, 14 weeks and 6, 9, 12 months of life. Random effects multivariable logistic regression method was used to assess factors associated with stunting, underweight and wasting. Results Among 737 HIV-exposed infants, 93 (13%) were HIV-infected by 12 months of age. Among HIV-infected and uninfected infants, baseline prevalence of stunting (48% vs. 46%), underweight (27% vs. 26%) and wasting (7% vs. 11%) was similar (p>0.29), but by 12 months stunting and underweight, but not wasting, were significantly higher in HIV-infected infants (80% vs. 56%, 52% vs. 29%, p< 0.0001; 5% vs. 6%, p=0.65, respectively). These differences rapidly manifested within 4–6 weeks of birth. Infants infected in utero had the worst growth outcomes during the follow-up period. SWEN was associated with non-significant reductions in stunting and underweight among HIV-infected infants and significantly less wasting in HIV-uninfected infants. In multivariate analysis, maternal CD4 < 250, infant HIV status, less breastfeeding, low birth weight, non-vaginal delivery, and infant gestational age were significant risk factors for underweight and stunting. Conclusion Baseline stunting and underweight was high in both HIV-infected and uninfected infants; growth indices diverged early and were impacted by timing of infection and SWEN prophylaxis. Early growth monitoring of all HIV-exposed infants is an important low-cost strategy for improving health and survival outcomes of these infants. Trial Registration NCT00061321
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Affiliation(s)
- Malathi Ram
- Johns Hopkins Bloomberg School of Public Health, Dept, of International Health/GDEC, Suite W5506, 615 N, Wolfe Street, Baltimore, MD 21205, USA.
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32
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Abstract
The delivery of safe and effective antiretroviral therapy to children and adolescents is crucial to save the lives of millions of children worldwide. The immunologic response to human immunodeficiency infection is closely related to a child's development and creates age-specific parameters for the evaluation of therapeutic response to antiretroviral therapy. Similarly, the development and maturation of organ systems involved in drug absorption, distribution, metabolism, and elimination determines significant changes in the pharmacokinetics of antiretroviral drugs throughout childhood. The authors review the evolution in treatment of pediatric HIV from infancy through adolescence.
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Affiliation(s)
- Natella Rakhmanina
- Division of Infectious Diseases, Children's National Medical Center, Washington, DC 20010, USA.
| | - Ryan Phelps
- Division of Infectious Disease, Washington University School of Medicine and Health Sciences, Washington, DC, USA,Department of Pediatrics, Children’s National Medical Center, Washington University School of Medicine and Health Sciences, Washington, DC, USA,USAID Office of HIV/AIDS, Washington, DC
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Effect of Baseline Immune Suppression on Growth Recovery in HIV Positive South African Children Receiving Antiretroviral Treatment. J Acquir Immune Defic Syndr 2012; 61:235-42. [DOI: 10.1097/qai.0b013e3182634e09] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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34
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Gsponer T, Weigel R, Davies MA, Bolton C, Moultrie H, Vaz P, Rabie H, Technau K, Ndirangu J, Eley B, Garone D, Wellington M, Giddy J, Ehmer J, Egger M, Keiser O. Variability of growth in children starting antiretroviral treatment in southern Africa. Pediatrics 2012; 130:e966-77. [PMID: 22987878 PMCID: PMC3457616 DOI: 10.1542/peds.2011-3020] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Poor growth is an indication for antiretroviral therapy (ART) and a criterion for treatment failure. We examined variability in growth response to ART in 12 programs in Malawi, Zambia, Zimbabwe, Mozambique, and South Africa. METHODS Treatment naïve children aged <10 years were included. We calculated weight for age z scores (WAZs), height for age z scores (HAZs), and weight for height z scores (WHZs) up to 3 years after starting ART, by using the World Health Organization standards. Multilevel regression models were used. RESULTS A total of 17990 children (range, 238-8975) were followed for 36181 person-years. At ART initiation, most children were underweight (50%) and stunted (66%). Lower baseline WAZ, HAZ, and WHZ were the most important determinants of faster catch-up growth on ART. WAZ and WHZ increased rapidly in the first year and stagnated or reversed thereafter, whereas HAZ increased continuously over time. Three years after starting ART, WAZ ranged from -2.80 (95% confidence interval [CI]: -3.66 to -2.02) to -1.98 (95% CI: -2.41 to -1.48) in children with a baseline z score < -3 and from -0.79 (95% CI: -1.62 to 0.02) to 0.05 (95% CI: -0.42 to 0.51) in children with a baseline WAZ ≥ -1. For HAZ, the corresponding range was -2.33 (95% CI: -2.62 to -2.02) to -1.27 (95% CI: -1.58 to -1.00) for baseline HAZ < -3 and -0.24 (95% CI: -0.56 to 0.15) to 0.84 (95% CI: 0.53 to 1.16) for HAZ ≥ -1. CONCLUSIONS Despite a sustained growth response and catch-up growth in children with advanced HIV disease treated with ART, normal weights and heights are not achieved over 3 years of ART.
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Affiliation(s)
- Thomas Gsponer
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Ralf Weigel
- Lighthouse Trust Clinic, Kamuzu Central Hospital, Lilongwe, Malawi;,Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Mary-Ann Davies
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Carolyn Bolton
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia;,University of Alabama, Birmingham, Alabama
| | - Harry Moultrie
- Wits Reproductive Health and HIV Institute (Harriet Shezi Children’s Clinic, Chris Hani Baragwanath Hospital, Soweto);,University of Witwatersrand, Johannesburg, South Africa
| | - Paula Vaz
- Paediatric Day Hospital, Maputo, Mozambique
| | - Helena Rabie
- Tygerberg Academic Hospital, University of Stellenbosch, Stellenbosch, South Africa
| | - Karl Technau
- University of Witwatersrand, Johannesburg, South Africa;,Empilweni Services and Research Unit (Rahima Moosa Mother and Child Hospital, Johannesburg)
| | - James Ndirangu
- Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Somkhele, South Africa
| | - Brian Eley
- Red Cross Children\x{2019}s Hospital and School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Daniela Garone
- Médecins Sans Frontières (MSF) South Africa, Khayelitsha, Cape Town, South Africa
| | | | - Janet Giddy
- Sinikithemba Clinic, McCord Hospital, Durban, South Africa; and
| | - Jochen Ehmer
- SolidarMed ART Programme, Zaka and Bikita Districts, Zimbabwe
| | - Matthias Egger
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Olivia Keiser
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
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Kapavarapu PK, Bari O, Perumpil M, Duggan C, Dinakar C, Krishnamurthy S, Arumugam K, Shet A. Growth patterns and anaemia status of HIV-infected children living in an institutional facility in India. Trop Med Int Health 2012; 17:962-71. [PMID: 22686454 PMCID: PMC3733082 DOI: 10.1111/j.1365-3156.2012.03022.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To understand the health status of HIV orphans in a well-structured institutional facility in India. METHOD Prospective longitudinal analysis of growth and anaemia prevalence among these children, between June 2008 and May 2011. RESULTS A total of 85 HIV-infected orphan children residing at Sneha Care Home, Bangalore, for at least 1 year, were included in the analysis. Prevalence of anaemia at entry into the home was 40%, with the cumulative incidence of anaemia during the study period being 85%. At baseline, 79% were underweight and 72% were stunted. All children, irrespective of their antiretroviral therapy (ART) status, showed an improvement in nutritional status over time as demonstrated by a significant increase in weight (median weight-for-age Z-score: -2.75 to -1.74, P < 0.001) and height Z-scores (median height-for-age Z-score: -2.69 to -1.63, P < 0.001). CONCLUSION These findings suggest that good nutrition even in the absence of ART can bring about improvement in growth. The Sneha Care Home model indicates that the holistic approach used in the Home may have been helpful in combating HIV and poor nutritional status in severely malnourished orphaned children.
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Affiliation(s)
| | | | | | - Christopher Duggan
- Clinical Nutrition Service, Division of GI/Nutrition, Children’s Hospital, Boston, MA, USA
| | - Chitra Dinakar
- Department of Pediatrics, St. John’s Medical College Hospital, Bangalore, India
| | | | - Karthika Arumugam
- Department of Biostatistics, St. John’s Research Institute, Bangalore, India
| | - Anita Shet
- Department of Pediatrics, St. John’s Medical College Hospital, Bangalore, India
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36
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Purchase SE, Van der Linden DJ, McKerrow NH. Feasibility and effectiveness of early initiation of combination antiretroviral therapy in HIV-infected infants in a government clinic of Kwazulu-Natal, South Africa. J Trop Pediatr 2012; 58:114-9. [PMID: 21705764 DOI: 10.1093/tropej/fmr053] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
A recent randomized trial showed dramatic improvement in survival of HIV-infected infants receiving early combination antiretroviral therapy (cART). However, few data are available for resource-limited settings. Therefore we conducted a chart review of HIV-infected infants initiated on cART between 2005 and 2008. Of 129 treated infants, 94 completed 6 months, 62 completed 12 months, and 39 completed 18 months of cART. Median age at initiation of cART was 8.6 months (range 2.1-11.9) and 77.2% had advanced disease. Undetectable VL was found in 78.8% of children who reached 18 months of treatment. CD4% increased from a median of 15.4% at baseline to 33.1% at 18 months. Weight for age Z-score increased from a mean ± SD of -2.7 ± 1.97 to 0.02 ± 1.10 at 18 months. Findings show favourable response to cART in HIV-infected infants outside a research environment, despite initial advanced disease. Efforts should be made to initiate cART as early as possible.
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Affiliation(s)
- Susan E Purchase
- Department of Paediatrics, Pietermarizburg Metropolitan Hospitals Complex, Pietermaritzburg, 3200, South Africa
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Venkatesh KK, Lurie MN, Triche EW, De Bruyn G, Harwell JI, McGarvey ST, Gray GE. Growth of infants born to HIV-infected women in South Africa according to maternal and infant characteristics. Trop Med Int Health 2011; 15:1364-74. [PMID: 20955499 DOI: 10.1111/j.1365-3156.2010.02634.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate growth parameters assessed by weight and length in HIV-infected and HIV-uninfected infants born to HIV-infected mothers in South Africa from birth to 6 months of age. METHODS We calculated z-scores for weight-for-age (WAZ), length-for-age (LAZ) and weight-for-length (WLZ) among a cohort of 840 mother-infant dyads. Multivariable Cox proportional hazards models with time-varying covariates were used to estimate the risk of falling <-2 z-scores for WAZ, LAZ, and WLZ as a function of infant and maternal characteristics. RESULTS By 6 months after birth, a fifth of infants had WAZ <-2, 19% had an LAZ <-2, and 29% had a WLZ <-2. WLZ and WAZ were significantly lower in HIV-infected infants than in uninfected infants by 3 months of age and LAZ by 6 months of age (P<0.001). The risk of WAZ falling <-2 was associated with decreasing maternal CD4 cell count (adj. HR for CD4 cell count <200 cells/μl: 1.64; 95% CI: 1.10-2.43), premature birth (adj. HR: 2.82; 95% CI: 2.06-3.86) and formula feeding (adj. HR: 3.35; 95% CI: 1.64-6.85). The risk of LAZ falling <-2 was associated with increasingly lower maternal age (adj. HR for<20 years: 0.54; 95% CI: 0.31-0.96), lower maternal CD4 cell count (adj. HR for CD4 cell count <200 cells/μl: 1.72; 95% CI: 1.14-2.59), premature birth (adj. HR: 2.37; 95% CI: 1.70-3.30) and formula feeding (adj. HR: 4.22; 95% CI: 1.85-9.62). The risk of WLZ falling <-2 was significantly associated with infant HIV infection (adj. HR: 1.64; 95% CI: 1.16-2.32) and formula feeding (adj. HR: 1.78; 95% CI: 1.11-2.83). The risk of WAZ and LAZ falling <-2 was more than two times greater for HIV-infected infants than for uninfected infants with gastrointestinal infections. CONCLUSIONS HIV-infected infants were more likely to be stunted and wasted than uninfected infants, which often occurred within 3 months after birth. Infants who were born to mothers with advanced HIV disease, formula-fed and co-infected with HIV and gastrointestinal infections were at greater risk for growth disturbances. Further interventions are needed to promptly initiate both HIV-infected mothers and infants on appropriate antiretroviral therapy and nutritional supplementation.
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Affiliation(s)
- Kartik K Venkatesh
- Department of Community Health, Alpert Medical School, Brown University, Providence, RI, USA
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Cadilla A, Qureshi N, Johnson DC. Pediatric antiretroviral therapy. Expert Rev Anti Infect Ther 2011; 8:1381-402. [PMID: 21133664 DOI: 10.1586/eri.10.127] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The rate of perinatal HIV transmission has decreased significantly in developed countries. However, worldwide, it remains the main source of HIV infection within the pediatric population. Recent advances as a result of findings from clinical trials, viral resistance testing and the advent of new drugs have increased the options for initial treatment regimens. This article provides an overview of antiretroviral therapy in treatment-naive children, including recent pediatric data and updated guidelines from the NIH. It also provides information on new drugs approved for the pediatric age group, dosage information, drug resistance testing and monitoring suggestions for children and adolescents receiving antiretroviral therapy. Special issues pertaining to adherence, disclosure and contraception are also highlighted.
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Affiliation(s)
- Adriana Cadilla
- University of Chicago, Pritzker School of Medicine, 5841 S. Maryland Avenue, MC6082, Chicago, IL 60637, USA
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Neely MN, Rakhmanina NY. Pharmacokinetic Optimization of Antiretroviral Therapy in Children and Adolescents. Clin Pharmacokinet 2011; 50:143-89. [DOI: 10.2165/11539260-000000000-00000] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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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.
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Contri PV, Berchielli EM, Tremeschin MH, Negrini BVDM, Salomão RG, Monteiro JP. Nutritional status and lipid profile of HIV-positive children and adolescents using antiretroviral therapy. Clinics (Sao Paulo) 2011; 66:997-1002. [PMID: 21808865 PMCID: PMC3129963 DOI: 10.1590/s1807-59322011000600013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2010] [Revised: 12/14/2010] [Accepted: 03/03/2011] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To describe nutritional status, body composition and lipid profile in children and adolescents receiving protease inhibitors. METHODS Fifty-nine patients, 23 treated with protease inhibitors (group 1) and 36 not using protease inhibitors (group 2). Their dietary intake, anthropometry, bioimpedance analysis and lipid profile variables were measured. RESULTS There was no difference in nutritional status or body composition between groups at the beginning of the study. After 6 months of follow-up, there was an increase in weight and height in both groups, as well as in waist circumference and subscapular skinfold thickness. In group 2, body mass index and triceps skinfold thickness adequacy were significantly higher after 6 months of follow-up. The groups had similar energy and macronutrient intake at any time point. After 6 months, group 1 had a higher cholesterol intake and group 2 had a higher fiber intake. Triglyceride serum levels were significantly different between the groups, with higher values in G1, at any time point [G1: 153 mg/dl (30-344); 138 (58-378) versus G2: 76 mg/dl (29-378); 76 (29-378)]. After 6 months of follow-up, G1 had higher LDL-cholesterol than G2 [104 mg/dl (40-142) versus 82 (42-145)]. CONCLUSION The use of protease inhibitors, per se, does not seem to significantly interfere with anthropometric measures, body composition and food intake of HIV-infected children and adolescents. However, this antiretroviral therapy was associated with a significant increase in triglyceride and LDL-cholesterol in our subjects.
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Affiliation(s)
- Patricia Viganó Contri
- Nutrition and Metabolism, Medical School of Ribeirão Preto, University of São Paulo Department of Pediatrics, Ribeirão Preto, São Paulo, Brazil.
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Viganò A, Cerini C, Pattarino G, Fasan S, Zuccotti GV. Metabolic complications associated with antiretroviral therapy in HIV-infected and HIV-exposed uninfected paediatric patients. Expert Opin Drug Saf 2010; 9:431-45. [PMID: 20078250 DOI: 10.1517/14740330903579991] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
IMPORTANCE OF THE FIELD HIV-infection has become a chronic disease in paediatric patients with the potential for long-term survival and exposure to antiretroviral (ARV) therapies for 2 decades longer than HIV-infected adults. On the other hand, the administration of ARV to HIV-infected pregnant women has greatly increased both treatment of HIV infection and prevention of perinatal HIV transmission. Therefore, researches aiming to evaluate the safety of ARV therapies in HIV-infected children as well as in HIV-uninfected infants born to HIV-infected mothers are emerging as a new challenge and urgent priority. AREAS COVERED IN THIS REVIEW The purpose of this review is to describe some of the more concerning metabolic complications associated with ARV in paediatric population: hyperlactataemia (HLA) syndromes, body shape abnormalities, disorders of glucose homeostasis and dyslipidaemia in HIV-infected children and adolescents. Frequency, risk factors, clinical findings, prevention and intervention strategies of the previously described abnormalities are discussed in depth. WHAT THE READER WILL GAIN This review covers our current understanding of HLA syndromes in ARV-exposed uninfected infants born to HIV-infected mothers. TAKE HOME MESSAGE Prevention of these metabolic complications should assume prominence and future researches should address several of the existing treatment gaps.
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Affiliation(s)
- Alessandra Viganò
- Università di Milano, Luigi Sacco Hospital, Department of Pediatrics, Milan, Italy.
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Monitoring Antiretroviral Therapy in HIV-Infected Children in Resource-Limited Countries: A Tale of Two Epidemics. AIDS Res Treat 2010; 2011:280901. [PMID: 21490777 PMCID: PMC3066553 DOI: 10.1155/2011/280901] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2010] [Accepted: 10/30/2010] [Indexed: 11/30/2022] Open
Abstract
Twenty-nine years into the HIV epidemic, several advances have been made; however, there remain several challenges particularly with pediatric HIV in resource-limited countries. The obstacles facing pediatric antiretroviral therapy (ART) delivery in resource-limited countries are multifaceted: lack of health care infrastructure, limited availability of pediatric drug formulations, lack of early HIV diagnostic and monitoring techniques, limited manpower with expertise in pediatric HIV care, limited donor funding, and competing public health priorities with limited health care budget. In this paper, the challenges with various ART monitoring tools in resource-limited countries are discussed. Noninvasive (e.g., patient, clinical events outcome, and adherence) and invasive (e.g., immunologic and virologic) monitoring tools are discussed. Several cheap and technically less complex laboratory tests for monitoring are becoming available. Funding agencies and country programs should invest in validating the use of current technologies to optimize pediatric HIV care in resource-limited countries.
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Musoke PM, Mudiope P, Barlow-Mosha LN, Ajuna P, Bagenda D, Mubiru MM, Tylleskar T, Fowler MG. Growth, immune and viral responses in HIV infected African children receiving highly active antiretroviral therapy: a prospective cohort study. BMC Pediatr 2010; 10:56. [PMID: 20691045 PMCID: PMC2923128 DOI: 10.1186/1471-2431-10-56] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2010] [Accepted: 08/06/2010] [Indexed: 11/25/2022] Open
Abstract
Background Scale up of paediatric antiretroviral therapy in resource limited settings continues despite limited access to routine laboratory monitoring. We documented the weight and height responses in HIV infected Ugandan children on highly active antiretroviral therapy and determined clinical factors associated with successful treatment outcomes. Methods A prospective cohort of HIV infected children were initiated on HAART and followed for 48 weeks. Body mass index for age z scores(BAZ), weight and height-for-age z scores (WAZ & HAZ) were calculated: CD4 cell % and HIV-1 RNA were measured at baseline and every 12 weeks. Treatment outcomes were classified according to; both virological and immunological success (VS/IS), virological failure and immunological success (VF/IS). virological success and immunological failure (VS/IF) and both virological and immunological failure (VF/IF). Results From March 2004 until May 2006, 124 HIV infected children were initiated on HAART. The median age (IQR) was 5.0 years (2.1 - 7.0) and 49% (61/124) were female. The median [95% confidence interval (CI)] BAZ, WAZ and HAZ at baseline were 0.29 (-2.9, -1.2), -1.2 (-2.1, -0.5) and -2.06 (-2.9, -1.2) respectively. Baseline median CD4 cell % and log10 HIV-1 RNA were; 11.8% (7.5-18.0) and 5.6 (5.2-5.8) copies/ml. By 48 weeks, mean WAZ and HAZ in the VF/IS group, which was younger, increased from - 0.98 (SD 1.7) to + 1.22 (SD 1.2) and from -1.99 (1.7) to + 0.76 (2.4) respectively. Mean increase in WAZ and HAZ in the VS/IF group, an older group was modest, from -1.84 (1.3) to - 0.41 (1.2) and -2.25 (1.2) to -1.16 (1.3) respectively. Baseline CD4 cell % [OR 6.97 95% CI (2.6 -18.6)], age [OR 4.6 95% CI (1.14 -19.1)] and WHO clinical stage [OR 3.5 95%CI (1.05 -12.7)] were associated with successful treatment outcome. Conclusions HIV infected Ugandan children demonstrated a robust increase in height and weight z scores during the first 48 weeks of HAART, including those who failed to completely suppress virus. Older children initiating HAART with severe immune suppression were less likely to achieve a successful treatment outcome. These data emphasize the importance of initiating HAART early to ensure adequate immune and growth responses.
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Affiliation(s)
- Philippa M Musoke
- Department of Paediatrics and Child Health, Makerere University, Kampala, Uganda.
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Weigel R, Phiri S, Chiputula F, Gumulira J, Brinkhof M, Gsponer T, Tweya H, Egger M, Keiser O. Growth response to antiretroviral treatment in HIV-infected children: a cohort study from Lilongwe, Malawi. Trop Med Int Health 2010; 15:934-44. [PMID: 20561308 DOI: 10.1111/j.1365-3156.2010.02561.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Malnutrition is common in HIV-infected children in Africa and an indication for antiretroviral treatment (ART). We examined anthropometric status and response to ART in children treated at a large public-sector clinic in Malawi. METHODS All children aged <15 years who started ART between January 2001 and December 2006 were included and followed until March 2008. Weight and height were measured at regular intervals from 1 year before to 2 years after the start of ART. Sex- and age-standardized z-scores were calculated for weight-for-age (WAZ) and height-for-age (HAZ). Predictors of growth were identified in multivariable mixed-effect models. RESULTS A total of 497 children started ART and were followed for 972 person-years. Median age (interquartile range; IQR) was 8 years (4-11 years). Most children were underweight (52% of children), stunted (69%), in advanced clinical stages (94% in WHO stages 3 or 4) and had severe immunodeficiency (77%). After starting ART, median (IQR) WAZ and HAZ increased from -2.1 (-2.7 to -1.3) and -2.6 (-3.6 to -1.8) to -1.4 (-2.1 to -0.8) and -1.8 (-2.4 to -1.1) at 24 months, respectively (P < 0.001). In multivariable models, baseline WAZ and HAZ scores were the most important determinants of growth trajectories on ART. CONCLUSIONS Despite a sustained growth response to ART among children remaining on therapy, normal values were not reached. Interventions leading to earlier HIV diagnosis and initiation of treatment could improve growth response.
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Affiliation(s)
- Ralf Weigel
- Ministry of Health and Lighthouse Trust at Kamuzu Central Hospital, Lilongwe, Malawi
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The influence of nutritional status on the response to HAART in HIV-infected children in South Africa. Pediatr Infect Dis J 2010; 29:511-3. [PMID: 20179664 DOI: 10.1097/inf.0b013e3181d1e989] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND While the impact of HAART on growth in children is well established, the influence of prior nutritional status on the response to HAART is not well known. METHODS A retrospective study was conducted on 120 children in South Africa. Patients were divided into 3 groups (normal, moderately underweight, and severely underweight) based on weight-for-age z-scores (WAZ). Age, weight, height, CD4 cell percentage, and viral load were recorded at initiation of HAART and after 24 months of therapy. Data were analyzed using t-tests, chi tests, and one-way ANOVA. RESULTS At baseline, 58% of children were normal weight, 18% moderately underweight, and 23% severely underweight. After 24 months of HAART, WAZ improved significantly in moderately and severely underweight patient groups compared with the normal group. Height-for-age z-scores (HAZ) increased in all 3 groups with severely underweight children gaining more height than normal weight counterparts. Weight-for-height z-scores (WHZ) normalized in the severely underweight group. Mean CD4 cell percentages increased significantly in all 3 groups while viral loads decreased significantly in all groups with no differences among the groups at the end of 24 months of therapy. Of the entire cohort, 75% achieved undetectable HIV RNA viral loads. CONCLUSIONS Underlying malnutrition does not adversely affect growth, immunologic or virologic response to HAART in HIV-infected children. Underweight children exhibit an equally robust response to treatment as their well-nourished peers.
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Affiliation(s)
- Gabriela Marón
- Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, TN, USA
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Sabery N, Duggan C. A.S.P.E.N. clinical guidelines: nutrition support of children with human immunodeficiency virus infection. JPEN J Parenter Enteral Nutr 2010; 33:588-606. [PMID: 19892900 DOI: 10.1177/0148607109346276] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Nasim Sabery
- Pediatric Gastroenterology and Nutrition, Children's Hospital Boston, Harvard School of Public Health, Boston, Massachusetts, USA
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Aurpibul L, Puthanakit T, Taecharoenkul S, Sirisanthana T, Sirisanthana V. Reversal of growth failure in HIV-infected Thai children treated with non-nucleoside reverse transcriptase inhibitor-based antiretroviral therapy. AIDS Patient Care STDS 2009; 23:1067-71. [PMID: 19909170 DOI: 10.1089/apc.2009.0093] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
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 <or=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-for-age (HAZ) z-scores were -2.02 (1.17) and -2.22 (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 = 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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Affiliation(s)
- Linda Aurpibul
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Thanyawee Puthanakit
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
| | | | - Thira Sirisanthana
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Virat Sirisanthana
- Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Isanaka S, Duggan C, Fawzi WW. Patterns of postnatal growth in HIV-infected and HIV-exposed children. Nutr Rev 2009; 67:343-59. [PMID: 19519675 DOI: 10.1111/j.1753-4887.2009.00207.x] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
HIV infection can contribute to disturbances in both linear growth and weight gain in early childhood, with disturbances often apparent as early as 3 months of age. There is little evidence for a difference in the early growth of HIV-exposed but uninfected children compared to healthy controls. Owing to the close association of growth with immune function and clinical progression, an understanding of growth patterns may be an important tool to ensure the provision of appropriate care to HIV-infected and exposed children. Timely growth monitoring may be used to improve the clinical course and quality of life of these children.
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Affiliation(s)
- Sheila Isanaka
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts 02115, USA.
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