Antiretroviral therapy in HIV infected children - a secondary analysis of growth parameters associated with age at initiation
Date
2018
Authors
Simelani, Lethabo Machaba
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Abstract
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.
Description
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