Abstract
The majority children living with HIV infection now survive into adulthood because of effective antiretroviral therapy (ART), but few data exist on their growth during adolescent years. This study investigated growth patterns and evaluated factors associated with suboptimal growth in adolescents with perinatally-acquired HIV infection. This retrospective cohort study included HIV-infected adolescents, aged 13 to 18 years, with at least 5 years of ART follow-up at a large HIV clinic in the Gauteng Province, South Africa. Weight-for-age Z-scores (WAZ), height-for-age Z-scores (HAZ) and body mass index (BMI)-for-age Z-scores were calculated using World Health Organization (WHO) growth standards. Growth velocity graphs were generated utilising the mean height change calculated at 6-monthly intervals, using all available data after ART initiation, to calculate the annual change. Other collected data included WHO HIV disease staging, CD4%, HIV viral loads (VLs), ART regimens and tuberculosis co-infection. Included were 288 children with a median age of 6.5 years (IQR 4.2;8.6 years) at ART initiation, and 51.7% were male. At baseline the majority of children had severe disease (92% WHO stages 3&4) and were started on non-nucleoside reverse transcriptase inhibitor-based regimens (79.2%). The median CD4% was 13.5% (IQR 7.9;18.9) and median HIV viral load log 5.0 (IQR 4.4;5.5). Baseline stunting (HAZ <-2) was prevalent (55.9%), with a median HAZ of -2.2 (IQR -3.1;-1.3). The median WAZ was -1.5 (IQR -2.5;-0.8), with 29.2% being underweight-for-age (WAZ <-2). The peak height velocity (PHV) in adolescents with baseline stage 3 disease was higher than for those with stage 4 disease. Being older at ART start (p<0.001) and baseline stunting (p<0.001) were associated with poorer growth, resulting in a lower HAZ at study exit, with boys more significantly affected than girls (p<0.001). Suboptimal growth in adolescents with perinatally-acquired HIV infection is a significant health concern, especially in children who started ART later in terms of age and who had baseline stunting and is more pronounced in boys than in girls.
Highlights
Children living with perinatally-acquired HIV infection are surviving into adulthood in large numbers, as HIV infection has become a treatable chronic condition due to the availability of antiretroviral therapy (ART) [1,2,3]
The majority children living with HIV infection survive into adulthood because of effective antiretroviral therapy (ART), but few data exist on their growth during adolescent years
Data on the prevalence and severity of delayed pubertal growth and stunting in HIV-infected adolescents in Sub-Saharan Africa are limited, most of the studies were done in younger children, as reported in a study done by Feucht et al in South Africa, where 20.2% of these children remain stunted after five years of ART [13]
Summary
Children living with perinatally-acquired HIV infection are surviving into adulthood in large numbers, as HIV infection has become a treatable chronic condition due to the availability of antiretroviral therapy (ART) [1,2,3]. Data on the prevalence and severity of delayed pubertal growth and stunting in HIV-infected adolescents in Sub-Saharan Africa are limited, most of the studies were done in younger children, as reported in a study done by Feucht et al in South Africa, where 20.2% of these children remain stunted after five years of ART [13]. This current study focused on factors associated with growth failure and a delayed and reduced pubertal growth spurt in adolescents living with perinatally-acquired HIV infection. This study investigated growth patterns and evaluated factors associated with suboptimal growth in adolescents with perinatally-acquired HIV infection.
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