Growth Failure as a Prognostic Indicator of Mortality in Pediatric HIV Infection

Berhane, Rahel; Bagenda, Danstan; Marum, Lawrence; Aceng, Esther; Ndugwa, Christopher M.; Bosch, Ronald J.; Olness, Karen

doi:10.1542/peds.100.1.e7

Cited by 112 publications

(92 citation statements)

References 20 publications

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“…The Rakai study 23 found that overall, for those <2 years of age, C(x < 2) ¼ 1.3, where C(x) is the ratio between uninfected children of infected mothers compared with those of uninfected mothers at age x, but there was some evidence of variation of C(x) with age, with C(x < 1) ¼ 1.1, and C(1 < x < 2) ¼ 1.8. A study in Kampala 24 showed a similar pattern with the same overall value for C(x < 2) ¼ 1.3 and a similar increase with age on subdivision of the interval.…”

Section: Discussionsupporting

confidence: 61%

Net survival of perinatally and postnatally HIV-infected children: a pooled analysis of individual data from sub-Saharan Africa

Marston

Becquet

Żaba

et al. 2011

International Journal of Epidemiology

149

122

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Section: Discussionsupporting

confidence: 61%

Net survival of perinatally and postnatally HIV-infected children: a pooled analysis of individual data from sub-Saharan Africa

Marston

Becquet

Żaba

et al. 2011

International Journal of Epidemiology

149

122

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“…5,6 Growth patterns before HAART therapy of HIV-1-infected children in developed countries are fairly well established, [7][8][9][10][11] although the exact mechanisms of these growth abnormalities are not as well understood. HIV-1-infected children in developed countries have similar birth weights compared with noninfected groups, but quickly diverge in both weight and height within the first months of life.…”

mentioning

confidence: 99%

The Effect of Protease Inhibitor Therapy on Growth and Body Composition in Human Immunodeficiency Virus Type 1-Infected Children

Miller¹,

Mawn

Orav

et al. 2001

Pediatrics

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ABSTRACT. Objective. To determine the effect of protease inhibitors (PIs) on growth and body composition in children with human immunodeficiency virus type 1 (HIV-1) infection.Background. HIV-1-infected children have chronic problems with both linear growth and weight gain. Viral load may directly influence growth and nutritional status of HIV-1-infected children with reduction of viral load improving the nutritional condition.Design/Methods. Data from 67 patients who initiated PI therapy between 1996 and 1999 and who were enrolled in a prospective, longitudinal study of growth and nutrition in HIV-1-infected children were analyzed. Outcomes included pre-PI versus post-PI measures of height, weight, weight-for-height, triceps skinfold thickness, and arm muscle circumference. Predictor covariates included age, race, gender, Tanner stage, CD4 z score, Centers for Disease Control and Prevention stage, route of infection, plasma HIV-1 RNA, other antiretroviral therapy, recommended daily allowances for calories, treatment with megestrol acetate, and PI therapy.Results. Sixty-seven children were followed for a median of 2.4 years with a total of 362 visits (median: 5 visits; range: 1-12). During follow-up, they received PIs for a median of 5 months. Fifty-one percent were girls, 54% black, 15% Hispanic, and 25% white. The mean age at first visit was 6.8 years. In a univariate analysis, weight z score (؊0.67 to ؊0.35) and weight/height z score (0.25-0.76) improved on PI therapy. Using repeated-measures regression analysis, controlling for the above named covariates, PI treatment showed a significant effect on weight z score (increase in z score by 0.46), weight/height z score (increase in z score by 0.49), and arm muscle circumference (increase in percentile by 11.5). A borderline effect was found for height z score (increase in z score by 0.17) and no effect was found for triceps skinfold thickness. In a separate analysis, PI therapy increased CD4 counts twofold and reduced plasma HIV-1 RNA copies by 79%.Conclusion. In addition to a significant reduction in viral load, PI therapy in children has a positive effect on several growth parameters, including weight, weight/ height, and muscle mass. 1 Survival time and quality of life for children living in countries with access to highly active antiretroviral therapy (HAART) have improved because of advances in medical therapy. Indeed, the goal of therapy in the United States has shifted from delayed disease progression to indefinite viral suppression. 2-4 With these developments, new questions relating to longterm changes in growth and body composition in both adults and children have arisen.Understanding the link between nutrition and the new therapeutic options available is critical, because nutritional status has been shown to be associated with pediatric HIV-1 disease progression. 5,6 Growth patterns before HAART therapy of HIV-1-infected children in developed countries are fairly well established, 7-11 although the exact mechanisms of these growth abnormalities are n...

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“…5 Growth may be one of the most sensitive indicators of disease progression in children who are living with HIV/AIDS. 3 Even in children who are taking antiretroviral drugs, the absence of growth is a poor prognostic indicator. Weight gain is also an important indicator of the effectiveness of antiretroviral therapy.…”

Section: Resultsmentioning

confidence: 99%

Longitudinal anthropometric assessment of infants born to HIV-1-infected mothers, Belo Horizonte, Southeastern Brazil

et al. 2011

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OBJECTIVE:To evaluate the growth parameters in infants who were born to HIV-1-infected mothers. METHODS:The study was a longitudinal evaluation of the z-scores for the weight-for-age (WAZ), weight-for-length (WLZ) and length-for-age (LAZ) data collected from a cohort. A total of 97 non-infected and 33 HIV-infected infants born to HIV-1-infected mothers in Belo Horizonte, Southeastern Brazil, between 1995 and 2003 was studied. The average follow-up period for the infected and non-infected children was 15.8 months (variation: 6.8 to 18.0 months) and 14.3 months (variation: 6.3 to 18.6 months), respectively. A mixed-effects linear regression model was used and was fi tted using a restricted maximum likelihood. RESULTS:There was an observed decrease over time in the WAZ, LAZ and WLZ among the infected infants. At six months of age, the mean differences in the WAZ, LAZ and WLZ between the HIV-infected and non-infected infants were 1.02, 0.59, and 0.63 standard deviations, respectively. At 12 months, the mean differences in the WAZ, LAZ and WLZ between the HIV-infected and non-infected infants were 1.15, 1.01, and 0.87 standard deviations, respectively. CONCLUSIONS:The precocious and increasing deterioration of the HIVinfected infants' anthropometric indicators demonstrates the importance of the early identifi cation of HIV-infected infants who are at nutritional risk and the importance of the continuous assessment of nutritional interventions for these infants.

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Growth Failure as a Prognostic Indicator of Mortality in Pediatric HIV Infection

Cited by 112 publications

References 20 publications

Net survival of perinatally and postnatally HIV-infected children: a pooled analysis of individual data from sub-Saharan Africa

Net survival of perinatally and postnatally HIV-infected children: a pooled analysis of individual data from sub-Saharan Africa

The Effect of Protease Inhibitor Therapy on Growth and Body Composition in Human Immunodeficiency Virus Type 1-Infected Children

Longitudinal anthropometric assessment of infants born to HIV-1-infected mothers, Belo Horizonte, Southeastern Brazil

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