Abstract:
OBEJECTIVES : To describe growth in HIV‐infected children on long‐term antiretroviral therapy (ART) and to
assess social, clinical, immunological and virological factors associated with suboptimal growth.
METHODS : This observational cohort study included all HIV‐infected children at an urban ART site in South
Africa who were younger than 5 years at ART initiation and with more than 5 years of follow‐up. Growth was
assessed using weight‐for‐age Z‐scores (WAZ), height‐for‐age Z‐scores (HAZ) and body mass index (BMI)‐forage
Z‐scores (BAZ). Children were stratified according to pre‐treatment anthropometry and age. Univariate
and mixed linear analysis was used to determine associations between independent variables and weight and
height outcomes.
RESULTS : Majority of the 159 children presented with advanced clinical disease (90%) and immunosuppression
(89%). Pre‐treatment underweight, stunting and wasting occurred commonly (WAZ<‐2= 50%, HAZ<‐2= 73%,
BAZ<‐2= 19%). Weight and BMI improvement occurred during the initial 12 months, while height improved
during the entire 5‐year period. Height at study exit was significantly worse for children with growth
impairment at ART initiation (p<0.001), whilst infants (<1 year) demonstrated superior improvement in terms
of BMI (p=0.04). Tuberculosis was an independent risk factor for suboptimal weight (p=0.01) and height
(p=0.02) improvement. Weight gain was additionally hindered by lack of electricity (p=0.04). Immune
reconstitution and virological suppression were not associated with being underweight or stunted at study end
point.
CONCLUSIONS : Malnutrition was a major clinical concern for this cohort of HIV‐infected children. Early ART
initiation, tuberculosis co‐infection management and nutritional interventions are crucial to ensure optimal
growth in HIV‐infected children.
