Growth and puberty in children with HIV infection

Abstract

Children with perinatal HIV infection may present with clinical features of endocrine dysfunction such as growth failure and pubertal delay. Pediatric care providers and pediatric endocrinologists should implement appropriate preventive, screening, and therapeutic strategies to maximize survival and quality of life in these children. Growth and pubertal delay can be exacerbated by a variety of treatable infectious, endocrine, nutritional, and immunological disorders. Timely diagnosis and appropriate treatment of these conditions may lead to improvement or even normalization of growth and puberty. HIV-infected children with advanced disease should undergo periodic growth evaluation, including GH levels, IGF-I, IGF binding protein 3 and androgens, in order to identify subclinical endocrine dysfunction. However, little is known about the association between HIV infection and endocrine dysfunction in children. Highly active antiretroviral therapy may also be associated with endocrine dysfunction with consequences on growth and puberty. Growth retardation and pubertal delay are always seen in children with advanced HIV infection and are often related to the proinflammatory milieu found in advanced AIDS. Growth and pubertal impairment are markers of advanced disease and require proper evaluation. A dysregulation of the hypothalamic-pituitary axis, toxic or allergic drug reactions may play a role in growth and pubertal delay of HIV-infected children. These dysfunctions require careful monitoring, in order to assess metabolic alterations that may be important in regulation of growth among HIV infected children. Better understanding of the mechanisms leading to impairment of growth and puberty in children with perinatal HIV-1 infection might lead to appropriate treatment when required.

The Prevalence and Determinants of Short Stature in HIV-Infected Children

“…4,5 The causes of HIV-related growth retardation are not completely understood and may include alteration in gastro-intestinal (GI) function, chronic infections, and endocrine dysfuntion. 15 It has been noted from our study that in children with virologic failure, the prevalence seems to be the highest among the age-group 13 to 18 years ( Figure 1), as compared to the younger age-groups. These teenagers represent a group of children who would have started HAART late, having survived for years without it, as HAART became universally available only in 2001.…”

Barriers to Provider-Initiated Testing and Counselling for Children in a High HIV Prevalence Setting: A Mixed Methods Study

“…There is also limited knowledge of the risk of vertically acquired HIV infection in older children [25]. Children with longstanding HIV infection, even with relatively preserved CD4 counts, are at risk of organ damage and growth failure, and HCWs need to be educated about the benefits of HIV testing even in asymptomatic, older children [26]–[28].…”

A growth reference for mid upper arm circumference for age among school age children and adolescents, and validation for mortality: growth curve construction and longitudinal cohort study

“…43 44 Importantly, undernutrition, inflammation, stress, or illnesses that typically occur in HIV infection or during humanitarian emergencies, may delay puberty. [45][46][47][48] While adjustment for the stage of sexual maturation and the onset of menarche may be technically desirable, and of value in interpreting an individual's growth, it may not always be culturally acceptable to evaluate these routinely in the settings where MUAC is likely to be most useful. For individual assessment of growth, changes over time, diet, and context are important factors.…”