Growth in the first 5years after antiretroviral therapy initiation among HIV-infected children in the IeDEA West African Pediatric Cohort.

Abstract

To describe growth evolution and its correlates in the first 5years of antiretroviral therapy (ART) initiation among HIV-infected children followed up in West Africa. All HIV-infected children younger than 10years followed in the IeDEA pWADA cohort while initiating ART, with at least one anthropometric measurement within the first 5years of treatment were included in the study. Growth was described according to the WHO child growth standards, using Weight-for-age Z-score (WAZ), Height-for-age Z-score (HAZ) and Weight-for-Height/BMI-for-age Z-score (WHZ/BAZ). Growth evolution and its correlates, measured at ART initiation, were modelled in individual linear mixed models for each anthropometric indicator, with a spline term added at the 12-, 24- and 9-month time point for WAZ, HAZ and WHZ/BAZ, respectively. Among the 4156 children selected (45% girls, median age at ART initiation 3.9years [IQR interquartile range 1.9-6.6], and overall 68% malnourished at ART initiation), important gains were observed in the first 12, 24 and 9months on ART for WAZ, HAZ and WHZ/BAZ, respectively. Correlates at ART initiation of a better growth evolution overtime were early age (<2years of age), severe immunodeficiency for age, and severity of malnutrition. Growth evolution is particularly strong within the first 2years on ART but slows down after this period. Weight and height gains help to recover from pre-ART growth deficiency but are insufficient for the most severely malnourished. The first year on ART could be the best period for nutritional interventions to optimize growth among HIV-infected children in the long-term.