Growth response to antiretroviral treatment in HIV-infected children: a cohort study from Lilongwe, Malawi

Abstract

Summary 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 (inter-quartile range; IQR) was 8 years (4 to 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.

Variability of Growth in Children Starting Antiretroviral Treatment in Southern Africa

“…To model the nonlinear increase of the anthropometric measurements on ART over time most accurately, we used a second order fractional polynomial transformation of time 22 as described previously. 1 All available weight and height measurements from ART initiation up to 3 years afterward were included in the analysis, provided the child had a baseline and at least 1 weight or height measurement after the start of ART. (1997-2005, 2005-2006, 2006-2007, and 2008-2010).…”

“…[1][2][3] Reasons for growth retardation are multifactorial and include genetic and environmental factors such as poor nutrition, low socioeconomic status, and infection by different pathogens. 4,5 All of these factors are interrelated and may decrease immunity and lead to malabsorption of food and to endocrine dysfunction.…”

“…4,5 All of these factors are interrelated and may decrease immunity and lead to malabsorption of food and to endocrine dysfunction. 6 Growth monitoring identifies HIV-infected children eligible for antiretroviral therapy (ART) and is useful to assess response to therapy, 1,7 and it is particularly important in many settings in sub-Saharan Africa with limited access to CD4 count and viral load monitoring to assess treatment failure.…”

Nutritional Supplementation in HIV-Infected Children: A Review

“…However, among the Malawian children neither the median weightfor-age Z-score nor the height-for-age Z-score reached normal values after two years on HAART among children who were underweight or stunted at initiation of HAART [22]. Likewise a study from Tanzania revealed that HIV-infected children on HAART were more likely to be underweight and/or wasted compared to HIV-uninfected children [24].…”

“…HIV-infected children from Malawi and Uganda had significant improvements in weight-for-age and height-forage Z-scores within one to two years of HAART initiation [22,23].…”