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Variability of growth in children starting antiretroviral treatment in Southern Africa | Journal Article / Research | MSF Science Portal
Journal Article
|Research

Variability of growth in children starting antiretroviral treatment in Southern Africa

Gsponer T, Weigel R, Davies MA, Bolton C, Moultrie H, Vaz P, Rabie H, Technau KG, Ndirangu J, Eley B, Garone DB, Wellington M, Giddy J, Ehmer J, Egger M, Keiser O

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Abstract
BACKGROUND
Poor growth is an indication for antiretroviral therapy (ART) and a criterion for treatment failure. We examined variability in growth response to ART in 12 programs in Malawi, Zambia, Zimbabwe, Mozambique, and South Africa.

METHODS
Treatment naïve children aged <10 years were included. We calculated weight for age z scores (WAZs), height for age z scores (HAZs), and weight for height z scores (WHZs) up to 3 years after starting ART, by using the World Health Organization standards. Multilevel regression models were used.

RESULTS
A total of 17 990 children (range, 238–8975) were followed for 36 181 person-years. At ART initiation, most children were underweight (50%) and stunted (66%). Lower baseline WAZ, HAZ, and WHZ were the most important determinants of faster catch-up growth on ART. WAZ and WHZ increased rapidly in the first year and stagnated or reversed thereafter, whereas HAZ increased continuously over time. Three years after starting ART, WAZ ranged from −2.80 (95% confidence interval [CI]: −3.66 to −2.02) to −1.98 (95% CI: −2.41 to −1.48) in children with a baseline z score < −3 and from −0.79 (95% CI: −1.62 to 0.02) to 0.05 (95% CI: −0.42 to 0.51) in children with a baseline WAZ ≥ −1. For HAZ, the corresponding range was −2.33 (95% CI: −2.62 to −2.02) to −1.27 (95% CI: −1.58 to −1.00) for baseline HAZ < −3 and −0.24 (95% CI: −0.56 to 0.15) to 0.84 (95% CI: 0.53 to 1.16) for HAZ ≥ −1.

CONCLUSIONS
Despite a sustained growth response and catch-up growth in children with advanced HIV disease treated with ART, normal weights and heights are not achieved over 3 years of ART.

Countries

Malawi Mozambique South Africa Zambia Zimbabwe

Subject Area

pediatricsHIV/AIDS

Languages

English
DOI
10.1542/peds.2011-3020
Published Date
17 Sep 2012
PubMed ID
22987878
Journal
Pediatrics
Volume | Issue | Pages
Volume 130, Issue 4, Pages e966-e977
Issue Date
2012-09-17
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