Growth in Virologically Suppressed HIV-Positive Children on Antiretroviral Therapy: Individual and Population-level References. Issue 10 (October 2015)

• Record Type: Journal Article
• Authors: Keiser, Olivia; Blaser, Nello; Davies, Mary-Ann; Wessa, Patrick; Eley, Brian; Moultrie, Harry; Rabie, Helena; Technau, Karl-Günther; Ndirangu, James; Garone, Daniela; Giddy, Janet; Grimwood, Ashraf; Gsponer, Thomas; Egger, Matthias
• Is Part Of: Pediatric infectious disease journal. Volume 34:Issue 10(2015)
• Publication Date: 2015-10
• Subjects: HIV -- antiretroviral therapy -- growth; Communicable diseases in children -- Periodicals; Infection in children -- Periodicals; 618.929
• DOI: 10.1097/INF.0000000000000801
• Languages: English
• ISSNs: 0891-3668

Abstract

Abstract : Background: Combination antiretroviral therapy (ART) suppresses viral replication in HIV-infected children. The growth of virologically suppressed children on ART has not been well documented. We aimed to develop dynamic reference curves for weight-for-age Z scores (WAZ) and height-for-age Z scores (HAZ). Methods: Children aged <11 years at ART initiation with continuously undetectable viral loads (<400 copies/mL) treated at 7 South African ART programs with routine viral load monitoring were included. We used multilevel models to define trajectories of WAZ and HAZ up to 3 years and developed a web application to monitor trajectories in individual children. Results: A total of 4876 children were followed for 7407 person-years. Analyses were stratified by baseline Z scores and age, which were the most important predictors of growth response. The youngest children showed the most pronounced increase in weight and height initially but catch-up growth stagnated after 1–2 years. Three years after starting ART, WAZ ranged from −2.2 [95% prediction interval (PrI), −5.6 to 0.8] in children with baseline age >5 years and Z score less than −3 to 0.0 (95% PrI, −2.7 to 2.4) in children with baseline age <2 years and WAZ greater than −1. For HAZ, the corresponding range was −2.3 (95% PrI, −4.9 to 0.3) in children with baseline age >5 years and Z score less than −3 to 0.3 (95% PrI, −3.1 to 3.4) in children with baseline age 2–5 years and HAZ greater than −1. Conclusions: We have developed an online tool to calculate reference trajectories in fully suppressed children. The web application could help to define "optimal" growth response and identify children with treatment failure. Abstract : Supplemental Digital Content is available in the text.