Early treated HIV-infected children remain at risk of growth retardation during the first five years of live: Results from the ANRS-Pediacam cohort in Cameroon

Abstract

Introduction Little is known about the long-term outcome of growth in early treated infants in resources limited countries. Here, we compared growth parameters over the first 5 years of life of early treated HIV-infected and uninfected children and identified factors associated with growth retardation, taking into account informative censorship. Methods Data used in this study were obtained from the ANRS-Pediacam cohort based in three referral hospitals in Cameroon (The Maternity of the Central hospital/Mother and Child Center of the Chantal Biya Foundation in Yaounde, the Essos Hospital Center in Yaounde and the Laquintinie Hospital in Douala). Anthropometric indices [weight-for-age (WAZ), weight-for-length (WLZ), and length-for-age (LAZ) Z-scores] were calculated using data from this observational study. Of the four groups included, three were followed from the first week of life: HIV-infected (HI, n = 69), HIV-exposed uninfected (HEU, n = 205) and HIV-unexposed uninfected (HUU, n = 196), and the last group constituted of HIV-infected infants not followed from first week of life but diagnosed before 7 months of age (HIL, n = 141). We performed under the Missing At Random hypothesis a multiple imputation by a conditional approach of missing data on different covariates, except the anthropometric parameters. To take account of informative censorship, recurrent events and interval censoring, we used markov multi-state model for panel data to describe the incidence of growth retardation (defined as WAZ or WLZ or LAZ Results During the first 5 years, 27.5% of children experienced underweight (WAZ P P = 0.01 respectively) and stunting for HIL (aHR = 8.4 (95%CI: 2.4–29.7). HEU and HUU infants were not different according to stunting and wasting. However, the risk of underweight was higher in HEU compared to HUU children (aHR = 5.0 (CI: 1.4–10.0), P = 0.001). Others associated factors were younger age, chronic pathologies, small size at birth, diarrhea, CD4 Conclusions Despite early antiretroviral treatment HIV-infected children are at high risk of wasting and stunting within the first 5 years period of follow up. Nutritional status of HIV infected children should be closely monitored even in the context of early treatment.