Abstract:
BACKGROUND :
The majority children living with HIV infection now survive into adulthood because of effective antiretroviral therapy (ART), but few data exist on their growth during adolescent years.
This study investigated growth patterns and evaluated factors associated with suboptimal
growth in adolescents with perinatally-acquired HIV infection.
METHODS :
This retrospective cohort study included HIV-infected adolescents, aged 13 to 18 years,
with at least 5 years of ART follow-up at a large HIV clinic in the Gauteng Province, South
Africa. Weight-for-age Z-scores (WAZ), height-for-age Z-scores (HAZ) and body mass
index (BMI)-for-age Z-scores were calculated using World Health Organization (WHO)
growth standards. Growth velocity graphs were generated utilising the mean height change
calculated at 6-monthly intervals, using all available data after ART initiation, to calculate the
annual change. Other collected data included WHO HIV disease staging, CD4%, HIV viral
loads (VLs), ART regimens and tuberculosis co-infection.
RESULTS :
Included were 288 children with a median age of 6.5 years (IQR 4.2;8.6 years) at ART initiation, and 51.7% were male. At baseline the majority of children had severe disease (92%
WHO stages 3&4) and were started on non-nucleoside reverse transcriptase inhibitorbased regimens (79.2%). The median CD4% was 13.5% (IQR 7.9;18.9) and median HIV
viral load log 5.0 (IQR 4.4;5.5). Baseline stunting (HAZ <-2) was prevalent (55.9%), with a
median HAZ of -2.2 (IQR -3.1;-1.3). The median WAZ was -1.5 (IQR -2.5;-0.8), with 29.2%
being underweight-for-age (WAZ <-2). The peak height velocity (PHV) in adolescents with
baseline stage 3 disease was higher than for those with stage 4 disease. Being older at ART start (p<0.001) and baseline stunting (p<0.001) were associated with poorer growth, resulting in a lower HAZ at study exit, with boys more significantly affected than girls (p<0.001).
CONCLUSIONS :
Suboptimal growth in adolescents with perinatally-acquired HIV infection is a significant
health concern, especially in children who started ART later in terms of age and who had
baseline stunting and is more pronounced in boys than in girls.
