Antiretroviral therapy in HIV infected children - a secondary analysis of growth parameters associated with age at initiation

Simelani, Lethabo Machaba
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Introduction: Growth failure in HIV infected children is a significant identifiable complication of HIV and can present as stunting, weight loss and or severe acute malnutrition (SAM). A description of the response of growth to ART initiated in young children is presented. Methods: A secondary data analysis of a prospective cohort of 292 HIV-infected children less than 3 years of age initiated on ART at a Johannesburg HIV Clinic between January 2004 and 31 August 2010 was done. Comparison of growth parameters for the time points 12, 24 and 36 months after initiation of ART was done in relation to age, gender, year of initiation, underweight for age (UWA), stunting or wasting at ART initiation. Results: At ART initiation, almost half the children were UWA (55%), 62% were stunted and 25% were classified as wasted The recovery of weight-for-age Z score (WAZ) and weight-for-height Z-score (WHZ) was much faster than the recovery of height-for-age Z-score (HAZ), however, analysis of all growth parameters showed a plateau of growth recovery after 3 years of follow-up. Lower WAZ was noted at initiation when compared to HAZ. UWA was more common in young children whereas stunting was more common in older children. Improvement after 3 years of follow up was noted for both weight and height but recovery of HAZ did not reach the population median as closely as WAZ did. Conclusion: ART has a positive effect on the over-all growth of HIV infected children. Age at initiation of ART was not the most important in supporting when to start ART, but having a Z-score <-2 was found to be critical. Despite sustained growth response and catch up growth in HIV-infected children on ART, normal weights and heights were not achieved after 3 years.
A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in fulfillment of the requirement for the degree of Master of Medicine in the Department of Paediatrics, Johannesburg 2018