Growth reconstitution following antiretroviral therapy and nutritional supplementation

McGrath, Christine J.; Diener, Lara C.; Richardson, Barbra A.; Peacock-Chambers, Elizabeth; John‐Stewart, Grace

doi:10.1097/qad.0000000000000783

Cited by 33 publications

(38 citation statements)

References 77 publications

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“…In our cohort, late age at ART initiation was strongly associated with stunting and poor HAZ evolution. This finding has been observed in many other studies, but mostly among children younger than age 10 years . Children who spend their first years of life with HIV without ART may have chronic inflammation due to uncontrolled HIV, which can affect growth.…”

Section: Discussionsupporting

confidence: 79%

“…Delayed pubertal onset is also observed in the general population in LMICs [41], and may reflect poor nutrition during the first 1000 days of life and in later childhood [42], which is often the case for children with HIV [22]. In rural villages of The Gambia, HAZ evolution was described from birth to 30 years and showed similar patterns to our study, with an apparent decline at the start of adolescence, especially for males, which could be explained by high rates of stunting during infancy and a later entry into puberty compared to the UK reference population [43].…”

Section: Discussionmentioning

confidence: 99%

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Stunting and growth velocity of adolescents with perinatally acquired HIV: differential evolution for males and females. A multiregional analysis from the IeDEA global paediatric collaboration

et al. 2019

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Introduction Stunting is a key issue for adolescents with perinatally acquired HIV (APH) that needs to be better understood. As part of the IeDEA multiregional consortium, we described growth evolution during adolescence for APH on antiretroviral therapy (ART). Methods We included data from sub‐Saharan Africa, the Asia‐Pacific, and the Caribbean, Central and South America regions collected between 2003 and 2016. Adolescents on ART, reporting perinatally acquired infection or entering HIV care before 10 years of age, with at least one height measurement between 10 and 16 years of age, and followed in care until at least 14 years of age were included. Characteristics at ART initiation and at 10 years of age were compared by sex. Correlates of growth defined by height‐for‐age z‐scores (HAZ) between ages 10 and 19 years were studied separately for males and females, using linear mixed models. Results Overall, 8737 APH were included, with 46% from Southern Africa. Median age at ART initiation was 8.1 years (interquartile range (IQR) 6.1 to 9.6), 50% were females, and 41% were stunted (HAZ<−2 SD) at ART initiation. Males and females did not differ by age and stunting at ART initiation, CD4 count over time or retention in care. At 10 years of age, 34% of males were stunted versus 39% of females (p < 0.001). Females had better subsequent growth, resulting in a higher prevalence of stunting for males compared to females by age 15 (48% vs. 25%) and 18 years (31% vs. 15%). In linear mixed models, older age at ART initiation and low CD4 count were associated with poor growth over time (p < 0.001). Those stunted at 10 years of age or at ART initiation had the greatest growth improvement during adolescence. Conclusions Prevalence of stunting is high among APH worldwide. Substantial sex‐based differences in growth evolution during adolescence were observed in this global cohort, which were not explained by differences in age of access to HIV care, degree of immunosuppression or region. Other factors influencing growth differences in APH, such as differences in pubertal development, should be better documented, to guide further research and inform interventions to optimize growth and health outcomes among APH.

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Section: Discussionsupporting

confidence: 79%

Section: Discussionmentioning

confidence: 99%

Stunting and growth velocity of adolescents with perinatally acquired HIV: differential evolution for males and females. A multiregional analysis from the IeDEA global paediatric collaboration

et al. 2019

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“…Both malnutrition and stunting are common among children and adolescents living with HIV in LMICs, with prevalence estimated as high as 42% and 73%, respectively [10*,73–76]. Malnutrition during the first year of life is associated with decreased lung function at one year of age [52*].…”

Section: Risk Factors For Hiv-associated Chronic Lung Disease Among Amentioning

confidence: 99%

Bronchiectasis and other chronic lung diseases in adolescents living with HIV

Attia

Miller

Ferrand

2017

Current Opinion in Infectious Diseases

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Purpose of review The incidence of pulmonary infections has declined dramatically with improved access to antiretroviral therapy (ART) and co-trimoxazole prophylaxis, but chronic lung disease (CLD) is an increasingly recognized but poorly understood complication in adolescents with perinatally-acquired HIV. Recent findings There is a high prevalence of chronic respiratory symptoms, abnormal spirometry and chest radiographic abnormalities among HIV-infected adolescents in sub-Saharan Africa, where 90% of the world’s HIV-infected children live. The incidence of lymphocytic interstitial pneumonitis, the most common cause of CLD in the pre-ART era, has declined with increased ART access. Small airways disease, particularly constrictive obliterative bronchiolitis and bronchiectasis are emerging as leading causes of CLD among HIV-infected adolescents in low- and middle-income countries. Asthma may be more common in high-income settings. Likely risk factors for CLD include recurrent pulmonary infections, air pollution, HIV-related immune dysfunction and untreated HIV infection, particularly during critical stages of lung development. Summary Globally, the importance of HIV-associated CLD as a cause of morbidity and mortality is increasing, especially as survival has improved dramatically with ART and growing numbers of children living with HIV enter adolescence. Further research is urgently needed to elucidate the natural history and pathogenesis of CLD, and to determine optimal screening, diagnostic and treatment strategies.

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“…WAZ is considered to be a marker of recent nutritional insult, while low HAZ reflects chronic issues of health and nutrition (20). Studies have shown variable recovery of height after initiating ART (21). Kabue et al reported improvement in HAZ at 1 year (p<0.05)(22); Mwiru et al (2014) likewise found improvement in HAZ, but children's HAZ scores never normalized despite catch-up growth (14).…”

Section: Discussionmentioning

confidence: 99%

“…While this reflects standard local practice and adds to generalizability of our results, it limits our analytical ability to evaluate and adjust for supplementation as a factor in growth improvement. Several studies have demonstrated positive effects from supplementation, but there is a need for additional research (21). …”

Section: Discussionmentioning

confidence: 99%

Growth Recovery Among HIV-infected Children Randomized to Lopinavir/Ritonavir or NNRTI-based Antiretroviral Therapy

Achan

Kakuru

Ikilezi

et al. 2016

Pediatric Infectious Disease Journal

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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 or non-nucleoside-reverse-transcription-inhibitor-based ART. Methods HIV-infected children 2 months to 6 years of age were randomized to Lopinavir/ritonavir- or non-nucleoside-reverse-transcription-inhibitor-based ART. Changes in weight-for-age (WAZ), height-for-age (HAZ), and weight-for-height (WHZ) Z-scores for 24 months were evaluated using generalized linear repeated-measures models. Recovery from being underweight (WAZ<−2), stunted (HAZ<−2) and wasted (WHZ<−2) to Z-scores > −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 Lopinavir/ritonavir-based and 65 non-nucleoside-reverse-transcription-inhibitor-based ART (nevirapine: 36 and efavirenz: 29). The median (IQR) difference in growth measures between baseline and 24 months for Lopinavir/ritonavir (n= 45) vs. non-nucleoside-reverse-transcription-inhibitor-based therapy (n=40) were as follows, WAZ: 0.47 (0.10, 1.62) vs. 0.53 (0.03, 1.14) (p=0.59) and HAZ: median 1.55 (0.78, 1.86) vs. 1.19 (0.62, 1.65) (p=0.23), respectively. ART regimen was not predictive of change in WAZ (beta: −0.02, 95%CI: −0.25, 0.20) or HAZ (beta: 0.05, 95%CI: −0.10, 0.19). 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 following ART-initiation, with no significant difference between those receiving Lopinavir/ritonavir vs. non-nucleoside-reverse-transcriptase-inhibitor-based ART. However, the persistence of median Z-scores below zero underscores the need for additional strategies to improve growth outcomes in HIV+ African children.

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Growth reconstitution following antiretroviral therapy and nutritional supplementation

Cited by 33 publications

References 77 publications

Stunting and growth velocity of adolescents with perinatally acquired HIV: differential evolution for males and females. A multiregional analysis from the IeDEA global paediatric collaboration

Stunting and growth velocity of adolescents with perinatally acquired HIV: differential evolution for males and females. A multiregional analysis from the IeDEA global paediatric collaboration

Bronchiectasis and other chronic lung diseases in adolescents living with HIV

Growth Recovery Among HIV-infected Children Randomized to Lopinavir/Ritonavir or NNRTI-based Antiretroviral Therapy

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