Influence of AIDS antiretroviral therapy on the growth pattern

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LILACS, Latin American and Caribbean Literature in Health Sciences; MEDLINE-PubMed, Medical Literature Analysis and Retrieval System Online – Public Medline." ] ] ] "textoCompleto" => "IntroductionOverall aspectsAcquired immunodeficiency syndrome (AIDS) is an infectious disease caused by the human immunodeficiency virus (HIV), which qualitatively and quantitatively affects the CD4+ T lymphocytes (CD4+ TL).<a class="elsevierStyleCrossRef" href="#bib0295">1</a> Vertical HIV transmission in childhood can occur at three distinct moments: (i) intrauterine-transplacental transmission; (ii) during labor and/or delivery; and (iii) through breastfeeding. Most cases (about 65%) occur during labor and delivery, with the remaining 35% occurring through intrauterine transmission, especially in the last weeks of gestation and when breastfeeding. Breastfeeding, as a transmission risk, is responsible for 7% to 22% of infection cases.<a class="elsevierStyleCrossRef" href="#bib0295">1</a>Global data for 2016 estimate that 36.7 (30.8–42.9) million individuals, of whom 2.1 million are children, are infected with HIV.<a class="elsevierStyleCrossRef" href="#bib0300">2</a> In Brazil, from 1980 to 2016, 842,710 cases of HIV infection were identified, of which approximately 24,900 represent children under 14 years old – a number that is possibly underestimated.<a class="elsevierStyleCrossRefs" href="#bib0305">3,4</a>Individuals infected with HIV have a reduction in the number of CD4+ TL – a hallmark characteristic of the immunological system status. The mechanism that results in failure to reconstitute CD4+ TL has not been fully elucidated, but it increases the risk of opportunistic infections. In addition to immunological changes, there are nutritional and endocrine-metabolic problems in AIDS, with HIV infection being associated with growth impairment.<a class="elsevierStyleCrossRef" href="#bib0315">5</a>Growth deficiency in AIDSChildren and adolescents with HIV infection show a greater prevalence of growth disorders, ranging from growth difficulties – resulting in weight and height below the normal range for age – to growth interruption and wasting syndrome.<a class="elsevierStyleCrossRef" href="#bib0320">6</a> Growth retardation is a disease severity progression indicator and a risk factor for death in individuals with AIDS.<a class="elsevierStyleCrossRef" href="#bib0325">7</a> Moreover, growth deficiency is multifactorial in AIDS, resulting from the effect of antiretroviral therapy, as well as other factors described below:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005">(i)malnutrition: may occur mainly due to inadequate nutritional intake secondary to anorexia, oral or upper digestive tract lesions (infectious cause), intake reduction (psychological or economic cause), or nutrient malabsorption (chronic diarrhea).<a class="elsevierStyleCrossRef" href="#bib0330">8</a> Another important aspect is the acceleration of protein catabolism and increased metabolic expenditure secondary to uncontrolled viral replication and the resulting inflammatory response (including cytokine network dysregulation), as well as opportunistic infections or neoplasms secondary to immunosuppression.<a class="elsevierStyleCrossRef" href="#bib0300">2</a> HIV-associated malnutrition was termed wasting syndrome<a class="elsevierStyleCrossRef" href="#bib0335">9</a>;</li><li class="elsevierStyleListItem" id="lsti0010">(ii)gastrointestinal disorders (malabsorption): may result from the HIV infection, opportunistic infections (enteric parasites, such as Cryptosporidium, Mycobacterium avium-intracellulare, and cytomegalovirus, among others) or neoplasms. Diarrhea, abdominal pain, and dysphagia are commonly observed in HIV-infected patients; however, intestinal malabsorption may occur in children with or without diarrhea.<a class="elsevierStyleCrossRef" href="#bib0340">10</a> Damage to mucosal integrity and increased permeability favor intestinal dysfunction, leading to the malabsorption of fats, carbohydrates, and proteins, interfering with weight and height development. Intestinal dysfunction may adversely interfere with the ability to absorb oral medications, including zidovudine (AZT, C10H13N5O4)<a class="elsevierStyleCrossRef" href="#bib0345">11</a>;</li><li class="elsevierStyleListItem" id="lsti0015">(iii)stress: in AIDS, the expression of cytokines, including interleukins (1 and 6), tumor necrosis factor-alpha, and interferon is altered, promoting metabolic stress, which may lead to loss of appetite, anorexia, and catabolism<a class="elsevierStyleCrossRef" href="#bib0335">9</a>;</li><li class="elsevierStyleListItem" id="lsti0020">(iv)chronic disease: HIV infection leads to a progressive reduction of the immune function, with a reduction in the number of CD4+ TL, concomitant to changes in the function of these cells and the main immune regulatory pathways. Therefore, the susceptibility to repeat infections and antibody deficiencies alter metabolism through infection and/or intake reduction and, thus, patient nutritional monitoring is required<a class="elsevierStyleCrossRef" href="#bib0330">8</a>;</li><li class="elsevierStyleListItem" id="lsti0025">(v)endocrine disorders: hormonal changes are probably caused by the viral infection itself or are secondary to endocrine gland involvement, due to opportunistic infections and/or medications used to treat infections and/or their complications.<a class="elsevierStyleCrossRef" href="#bib0350">12</a></li></ul>Hence, it is important to assess factors associated with growth deficit, reinforcing the need to broaden their understanding in order to minimize nutritional status losses.<a class="elsevierStyleCrossRef" href="#bib0345">11</a> Adequate monitoring by the multidisciplinary team contributes to the early detection of opportunistic infections, metabolic and hormonal changes, decreased food intake, nutrient malabsorption, and socioeconomic problems, probably resulting in benefits to weight and height development.<a class="elsevierStyleCrossRef" href="#bib0350">12</a>Antiretroviral therapy – general aspectsThe 1990s were a milestone in the treatment of AIDS, with the use of more effective antiretroviral regimens – highly active antiretroviral therapy. Initially, antiretroviral therapy was based on AZT monotherapy, but it showed low efficacy, requiring a progressive combination of drugs. Subsequently, dual therapy was introduced, with the use of new nucleoside analog reverse-transcriptase inhibitors. Subsequently, protease inhibitors and non-nucleoside reverse-transcriptase inhibitors appeared – a three-drug regimen that was referred to as combined antiretroviral therapy (cART). cART reduced HIV mortality, mainly in developed countries.<a class="elsevierStyleCrossRefs" href="#bib0320">6,13</a>Since 1996, cART has been used in childhood to minimize disease progression. It is estimated that without the use of antiretroviral therapy, one-third of HIV-infected children would die before one month, and more than half before two years of age.<a class="elsevierStyleCrossRef" href="#bib0360">14</a>Antiretroviral therapy – association with anthropometric and other dataAntiretroviral therapy in childhood and adolescence can result in metabolic disorders, mitochondrial toxicity, and adverse effects on nutritional status, especially in the first months of treatment. Patients may develop nausea or vomiting, lipodystrophy, and reduced bone mineralization.<a class="elsevierStyleCrossRef" href="#bib0300">2</a> Diagnosis and treatment of malnutrition is necessary, since micronutrient deficiency, especially of vitamins A, C, E, D, and minerals (e.g., selenium and iron), alters the immune system (which is already altered in AIDS) and reduces growth.<a class="elsevierStyleCrossRef" href="#bib0300">2</a>In adults, the duration of cART increases the risk of cardiovascular disease (stroke, infarction, and dilated cardiomyopathy). Thus, it is suggested that children using antiretrovirals are likely to have a higher risk of morbidity and premature cardiovascular mortality.<a class="elsevierStyleCrossRef" href="#bib0305">3</a> Moreover, immune activation, with persistent chronic inflammation in HIV-infected individuals, also increases the risk of cardiovascular disease and other diseases of inflammatory origin. Increased levels of inflammatory markers (C-reactive protein, interleukin 6, D-dimer, fibrinogen) associated with the risk of atherosclerosis and cancer, for instance, are also found in AIDS, and remain elevated regardless of the response to cART.<a class="elsevierStyleCrossRef" href="#bib0365">15</a> Finally, treatment adherence, which includes the use of cART, constitutes a challenge, mainly in childhood and adolescence, due to the chronic drug use, esthetic alterations related to lipodystrophy, and psychosocial aspects.<a class="elsevierStyleCrossRef" href="#bib0370">16</a>Growth in childhood and adolescence is crucial; hence, in the presence of AIDS, the positive and negative impact of cART should be assessed. Thus, the aim of this systematic review was to evaluate the association between antiretroviral therapy and growth in HIV-infected children and adolescents.MethodA systematic review was performed, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) strategy as eligibility criteria. In the PRISMA strategy, the population, intervention, comparison/control, outcome (PICO) technique was used to establish the study objective, as follows: P, children and adolescents from 0 to 19 years of age; I, individuals using cART; C, child growth; O, change in growth pattern.In the PRISMA strategy, the inclusion of studies published from 1996 (year of cART start) to September 2017 was selected. Original articles published in journals indexed in the English language were included. It was decided to include all types of studies, and among the selected articles, the classification was made by degree of recommendation and level of evidence.The searches were carried out in the Medical Literature Analysis and Retrieval System Online (MEDLINE-PubMed) and Latin American and Caribbean Health Sciences Literature (LILACS) databases, using the following descriptors: antiretroviral therapy, children, growth, HIV. The following filters were used: (i) presence of the descriptors in the title and/or abstract; (ii) publications in the last 21 years; (iii) being a scientific article. The excluded articles were: (i) those that had a duplicate in another electronic database of the bibliographic search; (ii) those about the cost of AIDS treatment, without addressing growth; (iii) those including children exposed to HIV, but not infected; (iii) those on perinatal growth; (iv) those about cART use in pregnant women; (v) those about the exclusive use of one or two antiretroviral drugs.A total of 549 articles were identified in the literature review, of which the following were selected by the title: 98 in MEDLINE-PubMed and 63 in LILACS. In the second evaluation, carried out by reading the abstract and by the exclusion of duplicate articles (69 articles), 92 articles were included – read in full. After being read in full, 44 studies were included in the systematic review (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The selected articles were classified by three authors (two physicians and one nutritionist), comprising the main items of the methods and results of each selected study (author, year, country of study origin, sample size, main results). All articles were evaluated and read by at least three authors, and the full-text reading was performed by drawing lots among the authors. Based on the data concordance, these were arranged in <a class="elsevierStyleCrossRefs" href="#tbl0005">Tables 1 and 2</a>.<a class="elsevierStyleCrossRefs" href="#bib0375">17–57</a> Therapeutic interventions performed with at least three antiretroviral drugs were included, without considering the cART type.<elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia>ResultsThe data obtained are summarized in <a class="elsevierStyleCrossRefs" href="#tbl0005">Tables 1 and 2</a>. After the summation of the assessed studies, a population of 51,992 HIV-infected individuals was included. In the studies, the positive response to cART, with growth improvement, was observed in 34 articles. However, concurrent improvement in weight and height development occurred in 33 studies. Most studies emphasized the importance of early diagnosis of HIV infection in children and adolescents, aiming to delay AIDS progression and start the use of cART as early as possible.In the literature, cART is associated with improvement in anthropometric and survival indexes. In the review, it was observed that 42,203/51,992 (81.17%) children showed improvement in the growth pattern with the use of cART.Of the articles included in the review, 42 have a degree of recommendation B ([i] one with level of evidence 2A; [ii] 35 with level of evidence 2B; [iii] six with level of evidence 2C) and two articles have level of evidence 1B (degree of recommendation A). Article classification for the level of evidence was performed according to recommendations of the Oxford Centre for Evidence-based Medicine.<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a> briefly shows the growth-related outcomes regarding the use of cART in HIV-infected children and adolescents.<elsevierMultimedia ident="fig0010"></elsevierMultimedia>DiscussionChanges in growth are common in HIV-infected children.<a class="elsevierStyleCrossRef" href="#bib0580">58</a> Growth disorders may be associated with: (i) opportunistic infections associated with the disease; (ii) absence of immunological and viral control at the follow-up; (iii) metabolic changes associated with HIV.<a class="elsevierStyleCrossRef" href="#bib0540">50</a> However, after the start of cART, changes in growth pattern have been used as effectiveness parameters in the treatment of children and adolescents with HIV.Based on this review carried out over the last 21 years, it can be observed that most of the studies showed a positive association in the height-age and weight-age Z-score with the use of cART (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). In addition to the anthropometric improvements, the literature demonstrates that cART has shown a decrease in morbidity, mortality, and hospitalization levels of patients infected with HIV. Treatment with cART increases CD4+ TL counts, reduces viral replication, and partially restores the immune system. As a result, it reduces the incidence of opportunistic infections.<a class="elsevierStyleCrossRefs" href="#bib0560">54,58</a> In 2003, Benjamin et al. reported that children using cART had fewer alterations in the immune system, a better response to the virus, and a better height-age Z-score curve.<a class="elsevierStyleCrossRef" href="#bib0310">4</a> Verweel et al., in 2002, showed decreases of 63.69% in hospitalizations after the introduction of cART.<a class="elsevierStyleCrossRef" href="#bib0560">54</a>The literature suggests that children who were treated in the past with monotherapy or dual therapy showed a temporary improvement in the growth rate. However, cART results in a lasting increase in the weight and height of infected children. This increase, however, did not reach the values close to those of the general population. In 2008, Buonora et al. demonstrated that, even with cART, infected patients had lower growth parameters than the non-HIV infected population.<a class="elsevierStyleCrossRef" href="#bib0495">41</a> Another study assessed that, after the introduction of cART, weight-age Z-score was close to that of the population without HIV infection, regardless of the time of treatment start. In turn, the height-age Z-score remained low.<a class="elsevierStyleCrossRef" href="#bib0420">26</a> Similar findings were observed in Europe, where after comparing growth curves of infected and non-infected children for ten years, it was concluded that HIV infection results in slower growth rates and that the differences increase with age.<a class="elsevierStyleCrossRef" href="#bib0555">53</a>Younger children may show greater weight and height recovery after the start of cART. Nachman et al. reported in 2005 that children younger than two years of age had a higher height Z-score during therapy.<a class="elsevierStyleCrossRef" href="#bib0535">49</a> Weight gain was also predominantly higher in younger patients.<a class="elsevierStyleCrossRef" href="#bib0535">49</a> In 2013, Shiau et al. evaluated a four-year follow-up of 195 AIDS patients and showed that patients who started cART before 6 months of age showed a faster improvement in weight-age and height-age Z-scores than those who started therapy later.<a class="elsevierStyleCrossRef" href="#bib0420">26</a> Therefore, the earlier the cART is initiated, the lower the growth deficit.<a class="elsevierStyleCrossRefs" href="#bib0420">26,37</a>Another important finding indicated in the studies refers to the nutritional status before treatment, as it can influence the anthropometric outcomes after the introduction of cART. Bandyopadhyay and Bhattacharyya showed in 2008 that malnourished children have worse results in the evolution of weight-age and height-age Z-scores compared to those who started therapy under adequate nutritional conditions.<a class="elsevierStyleCrossRef" href="#bib0510">44</a>In the review, one of the main limitations was the inclusion of many studies conducted in Africa, where nutritional deficiency may indirectly influence growth control and may represent a bias in the use of cART. Malnutrition and growth retardation occur early in HIV vertical transmission, and the negative impact of chronic infection and nutritional deficiency on growth may be irreversible.<a class="elsevierStyleCrossRef" href="#bib0450">32</a> However, the lack of growth pattern improvement occurred in studies carried out during a short period of time. For instance, in the 2011 study by Devi et al., who assessed 102 patients only in the first year of cART use.<a class="elsevierStyleCrossRef" href="#bib0450">32</a>Furthermore, the review did not compare the impact of different combined antiretroviral therapies with each other. Furthermore, it was not possible to analyze growth by age group. None of the studies compared groups undergoing cART, with and without virologic failure, to assess growth.Some studies have also highlighted the need to assess drug interactions in children and the potential adverse effects of cART on metabolism, but studies are still scarce in this age group. It is noteworthy that the possible metabolic effects of cART include insulin resistance, dyslipidemia, hyperlactatemia, and that such changes may lead to an increased risk for cardiovascular diseases and diabetes. The elevation of total cholesterol and lipodystrophy associated with the use of cART remains a challenge in the treatment of these patients. Factors associated with children's adherence to cART showed that low adherence was strongly associated with the caregivers’ profile (low level of schooling and/or degree of poverty).Based on the data described herein, the possible adverse effects of cART do not outweigh its benefits in terms of weight and height development, morbidity, and mortality in HIV-infected children. cART is known to play a role in the improvement of viral and immunological markers and may influence the growth of HIV-infected children. However, the increase in anthropometric markers (weight and height) did not normalize the growth when compared to the healthy population. The earlier the diagnosis of the HIV infection and, concurrently, of malnutrition and the initiation of cART, the lower the growth deficit when compared to healthy children. Patients with AIDS and without previous treatment for antiretroviral therapy show better anthropometric response to cART than previously treated patients. However, unfavorable socioeconomic and intrafamilial conditions influence treatment adherence, representing a limiting factor for more significant and long-lasting results of the use of cART in HIV infection treatment. Finally, mainly in countries with low economic resources to quantify the viral load, the improvement of anthropometric data during the use of cART as a parameter of therapeutic efficacy is more evident.FundingFALM, research support provided by Fundação de Amparo à Pesquisa do Estado de São Paulo – post-doctoral fellowship (# 2015/12858-5).Conflicts of interestThe authors declare no conflicts of interest." "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres1144834" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objectives" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Source of data" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Synthesis of data" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1075174" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1144833" "titulo" => "Resumo" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Fonte dos dados" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Síntese dos dados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusões" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1075175" "titulo" => "Palavras-chave" ] 4 => array:3 [ "identificador" => "sec0005" "titulo" => "Introduction" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0010" "titulo" => "Overall aspects" ] 1 => array:2 [ "identificador" => "sec0015" "titulo" => "Growth deficiency in AIDS" ] 2 => array:2 [ "identificador" => "sec0020" "titulo" => "Antiretroviral therapy – general aspects" ] 3 => array:2 [ "identificador" => "sec0025" "titulo" => "Antiretroviral therapy – association with anthropometric and other data" ] ] ] 5 => array:2 [ "identificador" => "sec0030" "titulo" => "Method" ] 6 => array:2 [ "identificador" => "sec0035" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0040" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0045" "titulo" => "Funding" ] 9 => array:2 [ "identificador" => "sec0050" "titulo" => "Conflicts of interest" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2017-10-18" "fechaAceptado" => "2017-12-07" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1075174" "palabras" => array:4 [ 0 => "Growth" 1 => "Children" 2 => "HIV" 3 => "Antiretroviral therapy" ] ] ] "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-chave" "identificador" => "xpalclavsec1075175" "palabras" => array:4 [ 0 => "Crescimento" 1 => "Crianças" 2 => "HIV" 3 => "Terapia antirretroviral" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "ObjectivesHuman immunodeficiency virus infection can result in the early impairment of anthropometric indicators in children and adolescents. However, combined antiretroviral therapy has improved, in addition to the immune response and viral infection, the weight and height development in infected individuals. Therefore, the objective was to evaluate the effect of combined antiretroviral on the growth development of human immunodeficiency virus infected children and adolescents. Source of dataA systematic review was performed. In the study, the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) strategy was used as the eligibility criterion. The MEDLINE-PubMed and LILACS databases were searched using these descriptors: HIV, children, growth, antiretroviral therapy. The objective was defined by the population, intervention, comparison/control, and outcome (PICO) technique. Inclusion and exclusion criteria were applied for study selection. Synthesis of dataOf the 549 studies indexed in MEDLINE-PubMed and LILACS, 73 were read in full, and 44 were included in the review (33 showed a positive impact of combined antiretroviral therapy on weight/height development, ten on weight gain, and one on height gain in children and adolescents infected with human immunodeficiency virus). However, the increase in growth was not enough to normalize the height of infected children when compared to children of the same age and gender without human immunodeficiency virus infection. ConclusionsCombined antiretroviral therapy, which is known to play a role in the improvement of viral and immunological markers, may influence in the weight and height development in children infected with human immunodeficiency virus. The earlier the infection diagnosis and, concomitantly, of malnutrition and the start of combined antiretroviral therapy, the lower the growth impairment when compared to healthy children." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objectives" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Source of data" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Synthesis of data" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "pt" => array:3 [ "titulo" => "Resumo" "resumen" => "ObjetivosA infecção pelo vírus da imunodeficiência humana pode comprometer, precocemente, os indicadores antropométricos de crianças e adolescentes. No entanto, a terapia antirretroviral combinada tem melhorado, além da resposta imunológica e da infecção viral, o ganho pôndero-estatural dos infectados. Dessa forma, nosso objetivo foi avaliar o efeito da terapia antirretroviral combinada no crescimento, de crianças e adolescentes, infectadas pelo vírus da imunodeficiência humana. Fonte dos dadosFoi realizada uma revisão sistemática. No estudo, adotou-se como critério de elegibilidade dos artigos, a estratégia PRISMA (preferred reporting items for systematic reviews and meta-analyses). Foram consultadas as bases de dados MEDLINE-PubMed e LILACS pelos descritores: HIV (vírus da imunodeficiência humana), children, growth, antiretroviral therapy. O objetivo foi definido pela estratégia PICO (population, intervention, comparison/control, outcome). Critérios de inclusão e exclusão foram aplicados na seleção dos estudos. Síntese dos dadosDos 549 estudos indexados no MEDLINE-PubMed e LILACS, 73 foram lidos na íntegra – 44 incluídos na revisão (33 demonstraram impacto positivo da terapia antirretroviral combinada no ganho pôndero-estatural, dez no ganho de peso e um no de estatura, em crianças e adolescentes, infectados com vírus da imunodeficiência humana). No entanto, o incremento no crescimento não foi o suficiente para normalizar a estatura de crianças infectadas, quando comparado com crianças da mesma idade e sexo, sem infecção pelo vírus da imunodeficiência humana. ConclusõesA terapia antirretroviral combinada que, conhecidamente, atua na melhora de marcadores virais e imunológicos, pode influenciar no ganho pôndero-estatural de crianças infectadas com vírus da imunodeficiência humana. Quanto mais precoce o diagnóstico da infecção e, concomitante, desnutrição e início da terapia antirretroviral combinada, menores serão os prejuízos no crescimento, quando comparado às crianças saudáveis." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Fonte dos dados" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Síntese dos dados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusões" ] ] ] ] "NotaPie" => array:2 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Golucci AP, Marson FA, Valente MF, Branco MM, Prado CC, Nogueira RJ. Influence of AIDS antiretroviral therapy on the growth pattern. J Pediatr (Rio J). 2019;95:7–17." ] 1 => array:2 [ "etiqueta" => "☆☆" "nota" => "Study conducted at the Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brazil." ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2785 "Ancho" => 2333 "Tamanyo" => 342587 ] ] "descripcion" => array:1 [ "en" => "Flow diagram of article selection used in the systematic review. LILACS, Latin American and Caribbean Literature in Health Sciences; MEDLINE-PubMed, Medical Literature Analysis and Retrieval System Online – Public Medline." ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2056 "Ancho" => 2350 "Tamanyo" => 411925 ] ] "descripcion" => array:1 [ "en" => "Outcome associated with the growth related to the use of cART in children and adolescents infected by HIV. cART, combined antiretroviral therapy; HIV, human immunodeficiency virus; CD4+ TL, CD4+ T lymphocytes." ] ] 2 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "USA, United States of America; DR, degree of recommendation; LE, level of evidence; BMI, body mass index; CD4+ TL, CD4+ T lymphocytes; HAART, highly-active antiretroviral therapy; cART, combined antiretroviral therapy." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Study (year) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Location \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Study design \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Subjects \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Main results \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">DR \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">LE \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Jesson et al. (2017)<a class="elsevierStyleCrossRef" href="#bib0340">10</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Africa \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Prospective cohort 6 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">158 children 1 to 15 years old \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Improvement in weight Z-score and anemia reduction \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">B \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2B \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ramteke et al. (2017)<a class="elsevierStyleCrossRef" href="#bib0335">9</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Africa \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Longitudinal cohort 1 year \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">553 children (300 controls) 4 to 9 years old \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Improvement in weight and height Z-scores. However, weight and height were not within the normality parameters when compared with the control group \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">B \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2B \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Cames et al. (2017)<a class="elsevierStyleCrossRef" href="#bib0330">8</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Senegal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Prospective Cohort 2 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">244 children 2 to 16 years old \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Improvement in height Z-score \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">B \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2B \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ebissa et al. (2016)<a class="elsevierStyleCrossRef" href="#bib0375">17</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Ethiopia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Retrospective Cohort 2 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">556 children 1 to 10 years old \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Improvement in weight and height Z-scores and increase of CD4+ TL lymphocytes The effect was greater in underweight children \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">B \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2B \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Achan et al. (2016)<a class="elsevierStyleCrossRef" href="#bib0380">18</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Africa \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Randomized trial 3 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">129 children 2 months to 6 years old \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Improvement in height and weight Z-scores \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">B \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2B \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hu et al. (2016)<a class="elsevierStyleCrossRef" href="#bib0385">19</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">China \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Retrospective Cohort 2 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">744 children 0 to 15 years old \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Improvement in weight and height Z-scores \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">B \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2B \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Feucht et al. (2016)<a class="elsevierStyleCrossRef" href="#bib0390">20</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">South Africa \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Observational cohort 3 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">159 children Less than 5 years old \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Improvement in weight and BMI Z-scores in the first 12 months, and in the height Z-score over 3 years of follow-up \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">B \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2B \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Schomaker et al. (2016)<a class="elsevierStyleCrossRef" href="#bib0395">21</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Africa \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Prospective cohort 3 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5826 children 2 to 5 years old \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Improvement in weight and height Z-scores and increase in CD4+ TL levels \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">B \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2B \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Tekleab et al. (2016)<a class="elsevierStyleCrossRef" href="#bib0400">22</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Ethiopia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Prospective 3 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">202 children 2 to 5 years old \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Improvement in weight and height Z-scores \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">B \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2C \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Chattopadhyay et al. (2016)<a class="elsevierStyleCrossRef" href="#bib0405">23</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">India \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cross-sectional 1 year \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">56 children (60 controls) 2 to 10 years old \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Improvement in weight and height Z-scores \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">B \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2B \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Yotebieng et al. (2015)<a class="elsevierStyleCrossRef" href="#bib0410">24</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Africa and Asia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Retrospective 2 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">7173 children 0 to 10 years old \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Improvement in weight-age Z-scores \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">B \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2B \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Kariminia et al. (2014)<a class="elsevierStyleCrossRef" href="#bib0415">25</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Asia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Retrospective cohort 9 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2608 patients 0 to 15 years old \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Improvement in weight and height Z-scores \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">B \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2B \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Shiau et al. (2013)<a class="elsevierStyleCrossRef" href="#bib0420">26</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">South Africa \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Prospective 4 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">195 patients 0 to 2 years old \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Children who started cART before 6 months of age showed a faster improvement in weight and height Z-scores when compared to those that started the therapy later \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">B \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2B \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Chhagan et al. (2012)<a class="elsevierStyleCrossRef" href="#bib0425">27</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Africa \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Prospective 2 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">151 prepubertal children \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Improvement in weight and height Z-scores \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">B \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2B \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Gsponer et al. (2012)<a class="elsevierStyleCrossRef" href="#bib0430">28</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Africa and South Africa \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Retrospective cohort \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">17,990 patients 0 to 10 years old \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Improvement of weight and height Z-scores. However, the weight and height for the parameters within the normality curve for age were not reached \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">B \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2B \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Sutcliffe et al. (2011)<a class="elsevierStyleCrossRef" href="#bib0435">29</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Zambia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Prospective cohort 2 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">193 patients 0 to 16 years old \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Improvement in weight and height Z-scores. The effect was higher in underweight children, and the lower height Z-score occurred in children older than 5 years. After 2 years of treatment, a large proportion of the children remained below weight and height for age \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">B \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2B \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">McGratha et al. (2011)<a class="elsevierStyleCrossRef" href="#bib0440">30</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Kenya \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Prospective cohort 4 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">173 patients 0 to 10 years old \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Improvement in weight for age Z-score, which was higher in children under 6 years. There was no improvement in height Z-score \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">B \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2B \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Diniz et al. (2011)<a class="elsevierStyleCrossRef" href="#bib0445">31</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Brazil \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Retrospective 3 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">196 patients 0 to 12 years old \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Better immune response and weight and height Z-scores were observed at the end of the follow-up \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">B \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2B \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Devi et al. (2011)<a class="elsevierStyleCrossRef" href="#bib0450">32</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">India \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Prospective 1 year \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">102 patients Mean age=74 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">In the first year of cART, there was improvement in the immune response and weight Z-score, but not height Z-score \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">B \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2B \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Naidoo et al. (2010)<a class="elsevierStyleCrossRef" href="#bib0455">33</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">South Africa \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Retrospective 8 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">120 children \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Improvement in weight and height Z-scores. There was no effect on the height of children with severe malnutrition. There was an increase in CD4+ TL lymphocytes and a reduction in viral load \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">B \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2C \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Chantry et al. (2010)<a class="elsevierStyleCrossRef" href="#bib0460">34</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">USA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Prospective/cohort – 48 weeks \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">97 patients – 1 month to 13 years old (incomplete) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Individuals starting or switching to cART were compared to the control group (HIV-exposed but uninfected children and demographic and anthropometric data from an American study). There was improvement in weight and height Z-scores, but no change in BMI Z-score. However, weight and height were lower than those of the healthy population \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">B \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2B \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Yotebieng et al. (2010)<a class="elsevierStyleCrossRef" href="#bib0465">35</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">South Africa \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Prospective cohort – 4 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1394 patients 0 to 15 years old \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Improvement in weight Z-score, but no change in height Z-score. Additionally, there was an improvement in CD4+ TL count \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">A \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1B \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Weigel et al. (2010)<a class="elsevierStyleCrossRef" href="#bib0470">36</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Malawi, Africa \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Prospective – 24 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">307 patients younger than 15 years old \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">There was an association between immunological response and weight and height Z-score improvement at the end of the follow-up \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">B \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2C \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Musoke et al. (2010)<a class="elsevierStyleCrossRef" href="#bib0475">37</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Uganda, Africa \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Prospective – 48 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">130 patients 6 months to 12 years old \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Increased weight and height Z-scores, with treatment, especially in individuals who started the therapy at a younger age \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">B \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2B \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Aurpibul et al. (2009)<a class="elsevierStyleCrossRef" href="#bib0480">38</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Thailand \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cohort – 5 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">225 patients 0 to 15 years old \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Compared with anthropometric reference data for Thai children, with no control group. There was a positive effect on weight and height Z-scores. At the same time, there was an increase in CD4+ TL count \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">B \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2B \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Davies et al. (2009)<a class="elsevierStyleCrossRef" href="#bib0485">39</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">South Africa \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Prospective cohort – 9 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6078 patients 0 to 16 years old \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Improvement in weight and height Z-scores \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">B \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2B \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Kabue et al. (2008)<a class="elsevierStyleCrossRef" href="#bib0490">40</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Uganda \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Retrospective – 3 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">749 patients – 0 to 19 years old \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Improvement in weight-age and height-age Z-scores. The viral or immunological response was not assessed. Moreover, the study does not specify the use of HAART \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">B \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2B \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Buonora et al. (2008)<a class="elsevierStyleCrossRef" href="#bib0495">41</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Brazil \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Retrospective – 97 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">108 patients 10 to 20 years old \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Even with HAART, height-age and weight-age Z-scores were lower than those of healthy individuals \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">B \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2B \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Kekitiinwa et al. (2008)<a class="elsevierStyleCrossRef" href="#bib0500">42</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">United Kingdom \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Prospective – 12 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1458 children Mean age 5 and 7.6 years old \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Improvement in weight-age and height-age Z-scores, especially in younger children \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">B \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2A \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Jaspan et al. (2008)<a class="elsevierStyleCrossRef" href="#bib0505">43</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">South Africa \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Retrospective cohort – 4 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">391 patients 9 to 59 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Improvement in weight Z-score, but height was not evaluated. Additionally, increased CD4+ TL levels were observed \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">B \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2B \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Bandyopadhyay and Bhattacharyya (2008)<a class="elsevierStyleCrossRef" href="#bib0510">44</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">India \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Prospective – 18 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">123 2 months to 8 years old \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Malnutrition before the start of cART might impair the outcome in nutritional parameters; there was an improvement only in the weight Z-score \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">B \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2B \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Zhang et al. (2007)<a class="elsevierStyleCrossRef" href="#bib0515">45</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">China \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Prospective – 12 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">83 children – 7 to 13 years old \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Improvement in weight and height Z-scores and the immunological response of patients \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">B \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2B \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Wamalwa et al. (2007)<a class="elsevierStyleCrossRef" href="#bib0520">46</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Kenya, Africa \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Prospective – 9 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">67 children 18 months to 12 years old \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Improvement in weight-age and height-age Z-scores. Additionally, the clinical response and viral control showed better results with the use of HAART \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">B \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2B \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Song et al. (2007)<a class="elsevierStyleCrossRef" href="#bib0525">47</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Kenya, Africa \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Retrospective – 1 year \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">29 children – Mean age=8.5 years old \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Improvement in weight-age Z-score \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">B \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2B \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Guillen et al. (2007)<a class="elsevierStyleCrossRef" href="#bib0530">48</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Spain \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Retrospective – 5 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">264 patients 0 to 18 years old \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Improvement in weight and height Z-scores and viral control in the first 5 years of cART \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">B \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2B \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Nachman et al. (2005)<a class="elsevierStyleCrossRef" href="#bib0535">49</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">USA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Prospective – 2 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">192 children 4 months to 17 years old \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">HAART allowed an increase in weight-age Z-score at week 48 and height-age at week 96. Younger children gained weight in less time \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">B \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2B \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Lodha et al. (2005)<a class="elsevierStyleCrossRef" href="#bib0540">50</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">India \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Prospective – 6 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">48 children – mean age=5.6 years old \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Improvement in weight-age Z-score during the 6-month period \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">B \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2C \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ghaffari et al. (2004)<a class="elsevierStyleCrossRef" href="#bib0545">51</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">USA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Prospective – 2 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">40 children 2 to18 years old \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Better immune response and higher weight and height Z-scores at the end of follow-up \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">B \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2B \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Kline et al. (2004)<a class="elsevierStyleCrossRef" href="#bib0550">52</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Romania \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Prospective – 67 weeks \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">452 children 0 to 18 years old \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Improvement in weight and height Z-scores and immunological response \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">B \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2C \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Newell et al. (2003)<a class="elsevierStyleCrossRef" href="#bib0555">53</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Europa (11 countries) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Prospective – 10 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1587 patients 0 to 10 years old \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Improvement in weight and height Z-scores with cART, regardless of clinical classification \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">B \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 B \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Verwell et al. (2002)<a class="elsevierStyleCrossRef" href="#bib0560">54</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Netherlands \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Prospective study \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">24 children – 4 months to 16 years old (96 weeks of treatment) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No control group was included, but rather reference curves from the Netherlands. Improvement in weight and height Z-scores in patients with reduced viral load and BMI Z-score in patients with advanced stage of disease and malnutrition \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">B \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2C \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Nachman et al. (2002)<a class="elsevierStyleCrossRef" href="#bib0565">55</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">USA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Prospective – 120 weeks \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">197 patients – 2 to 17 years old \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">It was found that the growth deficit increased over time, even in the individuals with better viral load control \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">A \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1B \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Miller et al. (2001)<a class="elsevierStyleCrossRef" href="#bib0570">56</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">USA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cohort – 3 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">67 patients – 0 to 3.8 years old \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Control group was not included. Improvement in weight and weight/height Z-scores, as well as reduction in viral load, but there was no effect on height \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">B \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2B \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Buchacz et al. (2001)<a class="elsevierStyleCrossRef" href="#bib0575">57</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">USA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Prospective – 3 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">906 patients – 3 months to 18 years old \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Improvement in weight and height Z-scores with cART containing protease inhibitor, regardless of clinical classification \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">B \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2B \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1953442.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Data obtained from the studies according to year of publication, study location, study design, assessed sample, main results obtained, degree of recommendation, and level of evidence." ] ] 3 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "cART, combined antiretroviral therapy; HIV, human immunodeficiency virus." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Outcome \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Number of studies \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Positive – n (%) \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Height improvement \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1/44 (2.27%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">244/51,992 (0.47%)<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Weight improvement \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10/44 (22.73%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">9789/51,992 (18.83%)<a class="elsevierStyleCrossRef" href="#tblfn0010">b</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Weight and height improvement \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">33/44 (75%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">41,959/51,992 (80.7%)<a class="elsevierStyleCrossRef" href="#tblfn0015">c</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1953443.png" ] ] ] "notaPie" => array:3 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "Cames et al., 2017.<a class="elsevierStyleCrossRef" href="#bib0330">8</a>" ] 1 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "b" "nota" => "Jesson et al., 2017<a class="elsevierStyleCrossRef" href="#bib0340">10</a>; 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Influência da terapia antirretroviral para a AIDS no padrão de crescimento

Ana Paula Brigatto Simões Goluccia, Fernando Augusto Lima Marsona,b, Mariana Freitas Fedato Valentec, Maira Migliari Brancoc, Camila Carbone Pradoc, Roberto José Negrão Nogueiraa,d,

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nutrigene@uol.com.br

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a Universidade Estadual de Campinas (UNICAMP), Faculdade de Ciências Médicas, Departamento de Pediatria, Campinas, SP, Brazil

b Universidade Estadual de Campinas (UNICAMP), Faculdade de Ciências Médicas, Departamento de Genética Médica, Campinas, SP, Brazil

c Universidade Estadual de Campinas (UNICAMP), Faculdade de Ciências Médicas, Hospital de Clínicas, Campinas, SP, Brazil

d Faculdade São Leopoldo Mandic, Campinas, SP, Brazil

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in AIDS&#44; the expression of cytokines&#44; including interleukins &#40;1 and 6&#41;&#44; tumor necrosis factor-alpha&#44; and interferon is altered&#44; promoting metabolic stress&#44; which may lead to loss of appetite&#44; anorexia&#44; and catabolism<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">9</span></a>&#59;</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">&#40;iv&#41;</span><p id="par0040" class="elsevierStylePara elsevierViewall">chronic disease&#58; HIV infection leads to a progressive reduction of the immune function&#44; with a reduction in the number of CD4<span class="elsevierStyleSup">&#43;</span> TL&#44; concomitant to changes in the function of these cells and the main immune regulatory pathways&#46; Therefore&#44; the susceptibility to repeat infections and antibody deficiencies alter metabolism through infection and&#47;or intake reduction and&#44; thus&#44; patient nutritional monitoring is required<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">8</span></a>&#59;</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">&#40;v&#41;</span><p id="par0045" class="elsevierStylePara elsevierViewall">endocrine disorders&#58; hormonal changes are probably caused by the viral infection itself or are secondary to endocrine gland involvement&#44; due to opportunistic infections and&#47;or medications used to treat infections and&#47;or their complications&#46;<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">12</span></a></p></li></ul></p><p id="par0050" class="elsevierStylePara elsevierViewall">Hence&#44; it is important to assess factors associated with growth deficit&#44; reinforcing the need to broaden their understanding in order to minimize nutritional status losses&#46;<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">11</span></a> Adequate monitoring by the multidisciplinary team contributes to the early detection of opportunistic infections&#44; metabolic and hormonal changes&#44; decreased food intake&#44; nutrient malabsorption&#44; and socioeconomic problems&#44; probably resulting in benefits to weight and height development&#46;<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">12</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Antiretroviral therapy &#8211; general aspects</span><p id="par0055" class="elsevierStylePara elsevierViewall">The 1990s were a milestone in the treatment of AIDS&#44; with the use of more effective antiretroviral regimens &#8211; highly active antiretroviral therapy&#46; Initially&#44; antiretroviral therapy was based on AZT monotherapy&#44; but it showed low efficacy&#44; requiring a progressive combination of drugs&#46; Subsequently&#44; dual therapy was introduced&#44; with the use of new nucleoside analog reverse-transcriptase inhibitors&#46; Subsequently&#44; protease inhibitors and non-nucleoside reverse-transcriptase inhibitors appeared &#8211; a three-drug regimen that was referred to as combined antiretroviral therapy &#40;cART&#41;&#46; cART reduced HIV mortality&#44; mainly in developed countries&#46;<a class="elsevierStyleCrossRefs" href="#bib0320"><span class="elsevierStyleSup">6&#44;13</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Since 1996&#44; cART has been used in childhood to minimize disease progression&#46; It is estimated that without the use of antiretroviral therapy&#44; one-third of HIV-infected children would die before one month&#44; and more than half before two years of age&#46;<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">14</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Antiretroviral therapy &#8211; association with anthropometric and other data</span><p id="par0065" class="elsevierStylePara elsevierViewall">Antiretroviral therapy in childhood and adolescence can result in metabolic disorders&#44; mitochondrial toxicity&#44; and adverse effects on nutritional status&#44; especially in the first months of treatment&#46; Patients may develop nausea or vomiting&#44; lipodystrophy&#44; and reduced bone mineralization&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">2</span></a> Diagnosis and treatment of malnutrition is necessary&#44; since micronutrient deficiency&#44; especially of vitamins A&#44; C&#44; E&#44; D&#44; and minerals &#40;<span class="elsevierStyleItalic">e&#46;g&#46;</span>&#44; selenium and iron&#41;&#44; alters the immune system &#40;which is already altered in AIDS&#41; and reduces growth&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">2</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">In adults&#44; the duration of cART increases the risk of cardiovascular disease &#40;stroke&#44; infarction&#44; and dilated cardiomyopathy&#41;&#46; Thus&#44; it is suggested that children using antiretrovirals are likely to have a higher risk of morbidity and premature cardiovascular mortality&#46;<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">3</span></a> Moreover&#44; immune activation&#44; with persistent chronic inflammation in HIV-infected individuals&#44; also increases the risk of cardiovascular disease and other diseases of inflammatory origin&#46; Increased levels of inflammatory markers &#40;C-reactive protein&#44; interleukin 6&#44; D-dimer&#44; fibrinogen&#41; associated with the risk of atherosclerosis and cancer&#44; for instance&#44; are also found in AIDS&#44; and remain elevated regardless of the response to cART&#46;<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">15</span></a> Finally&#44; treatment adherence&#44; which includes the use of cART&#44; constitutes a challenge&#44; mainly in childhood and adolescence&#44; due to the chronic drug use&#44; esthetic alterations related to lipodystrophy&#44; and psychosocial aspects&#46;<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">16</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">Growth in childhood and adolescence is crucial&#59; hence&#44; in the presence of AIDS&#44; the positive and negative impact of cART should be assessed&#46; Thus&#44; the aim of this systematic review was to evaluate the association between antiretroviral therapy and growth in HIV-infected children and adolescents&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Method</span><p id="par0080" class="elsevierStylePara elsevierViewall">A systematic review was performed&#44; using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses &#40;PRISMA&#41; strategy as eligibility criteria&#46; In the PRISMA strategy&#44; the population&#44; intervention&#44; comparison&#47;control&#44; outcome &#40;PICO&#41; technique was used to establish the study objective&#44; as follows&#58; P&#44; children and adolescents from 0 to 19 years of age&#59; I&#44; individuals using cART&#59; C&#44; child growth&#59; O&#44; change in growth pattern&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">In the PRISMA strategy&#44; the inclusion of studies published from 1996 &#40;year of cART start&#41; to September 2017 was selected&#46; Original articles published in journals indexed in the English language were included&#46; It was decided to include all types of studies&#44; and among the selected articles&#44; the classification was made by degree of recommendation and level of evidence&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">The searches were carried out in the Medical Literature Analysis and Retrieval System Online &#40;MEDLINE-PubMed&#41; and Latin American and Caribbean Health Sciences Literature &#40;LILACS&#41; databases&#44; using the following descriptors&#58; antiretroviral therapy&#44; children&#44; growth&#44; HIV&#46; The following filters were used&#58; &#40;i&#41; presence of the descriptors in the title and&#47;or abstract&#59; &#40;ii&#41; publications in the last 21 years&#59; &#40;iii&#41; being a scientific article&#46; The excluded articles were&#58; &#40;i&#41; those that had a duplicate in another electronic database of the bibliographic search&#59; &#40;ii&#41; those about the cost of AIDS treatment&#44; without addressing growth&#59; &#40;iii&#41; those including children exposed to HIV&#44; but not infected&#59; &#40;iii&#41; those on perinatal growth&#59; &#40;iv&#41; those about cART use in pregnant women&#59; &#40;v&#41; those about the exclusive use of one or two antiretroviral drugs&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">A total of 549 articles were identified in the literature review&#44; of which the following were selected by the title&#58; 98 in MEDLINE-PubMed and 63 in LILACS&#46; In the second evaluation&#44; carried out by reading the abstract and by the exclusion of duplicate articles &#40;69 articles&#41;&#44; 92 articles were included &#8211; read in full&#46; After being read in full&#44; 44 studies were included in the systematic review &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; The selected articles were classified by three authors &#40;two physicians and one nutritionist&#41;&#44; comprising the main items of the methods and results of each selected study &#40;author&#44; year&#44; country of study origin&#44; sample size&#44; main results&#41;&#46; All articles were evaluated and read by at least three authors&#44; and the full-text reading was performed by drawing lots among the authors&#46; Based on the data concordance&#44; these were arranged in <a class="elsevierStyleCrossRefs" href="#tbl0005">Tables 1 and 2</a>&#46;<a class="elsevierStyleCrossRefs" href="#bib0375"><span class="elsevierStyleSup">17&#8211;57</span></a> Therapeutic interventions performed with at least three antiretroviral drugs were included&#44; without considering the cART type&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Results</span><p id="par0100" class="elsevierStylePara elsevierViewall">The data obtained are summarized in <a class="elsevierStyleCrossRefs" href="#tbl0005">Tables 1 and 2</a>&#46; After the summation of the assessed studies&#44; a population of 51&#44;992 HIV-infected individuals was included&#46; In the studies&#44; the positive response to cART&#44; with growth improvement&#44; was observed in 34 articles&#46; However&#44; concurrent improvement in weight and height development occurred in 33 studies&#46; Most studies emphasized the importance of early diagnosis of HIV infection in children and adolescents&#44; aiming to delay AIDS progression and start the use of cART as early as possible&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">In the literature&#44; cART is associated with improvement in anthropometric and survival indexes&#46; In the review&#44; it was observed that 42&#44;203&#47;51&#44;992 &#40;81&#46;17&#37;&#41; children showed improvement in the growth pattern with the use of cART&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Of the articles included in the review&#44; 42 have a degree of recommendation B &#40;&#91;i&#93; one with level of evidence 2A&#59; &#91;ii&#93; 35 with level of evidence 2B&#59; &#91;iii&#93; six with level of evidence 2C&#41; and two articles have level of evidence 1B &#40;degree of recommendation A&#41;&#46; Article classification for the level of evidence was performed according to recommendations of the Oxford Centre for Evidence-based Medicine&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a> briefly shows the growth-related outcomes regarding the use of cART in HIV-infected children and adolescents&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Discussion</span><p id="par0120" class="elsevierStylePara elsevierViewall">Changes in growth are common in HIV-infected children&#46;<a class="elsevierStyleCrossRef" href="#bib0580"><span class="elsevierStyleSup">58</span></a> Growth disorders may be associated with&#58; &#40;i&#41; opportunistic infections associated with the disease&#59; &#40;ii&#41; absence of immunological and viral control at the follow-up&#59; &#40;iii&#41; metabolic changes associated with HIV&#46;<a class="elsevierStyleCrossRef" href="#bib0540"><span class="elsevierStyleSup">50</span></a> However&#44; after the start of cART&#44; changes in growth pattern have been used as effectiveness parameters in the treatment of children and adolescents with HIV&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Based on this review carried out over the last 21 years&#44; it can be observed that most of the studies showed a positive association in the height-age and weight-age <span class="elsevierStyleItalic">Z</span>-score with the use of cART &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; In addition to the anthropometric improvements&#44; the literature demonstrates that cART has shown a decrease in morbidity&#44; mortality&#44; and hospitalization levels of patients infected with HIV&#46; Treatment with cART increases CD4<span class="elsevierStyleSup">&#43;</span> TL counts&#44; reduces viral replication&#44; and partially restores the immune system&#46; As a result&#44; it reduces the incidence of opportunistic infections&#46;<a class="elsevierStyleCrossRefs" href="#bib0560"><span class="elsevierStyleSup">54&#44;58</span></a> In 2003&#44; Benjamin et al&#46; reported that children using cART had fewer alterations in the immune system&#44; a better response to the virus&#44; and a better height-age <span class="elsevierStyleItalic">Z</span>-score curve&#46;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">4</span></a> Verweel et al&#46;&#44; in 2002&#44; showed decreases of 63&#46;69&#37; in hospitalizations after the introduction of cART&#46;<a class="elsevierStyleCrossRef" href="#bib0560"><span class="elsevierStyleSup">54</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">The literature suggests that children who were treated in the past with monotherapy or dual therapy showed a temporary improvement in the growth rate&#46; However&#44; cART results in a lasting increase in the weight and height of infected children&#46; This increase&#44; however&#44; did not reach the values close to those of the general population&#46; In 2008&#44; Buonora et al&#46; demonstrated that&#44; even with cART&#44; infected patients had lower growth parameters than the non-HIV infected population&#46;<a class="elsevierStyleCrossRef" href="#bib0495"><span class="elsevierStyleSup">41</span></a> Another study assessed that&#44; after the introduction of cART&#44; weight-age <span class="elsevierStyleItalic">Z</span>-score was close to that of the population without HIV infection&#44; regardless of the time of treatment start&#46; In turn&#44; the height-age <span class="elsevierStyleItalic">Z</span>-score remained low&#46;<a class="elsevierStyleCrossRef" href="#bib0420"><span class="elsevierStyleSup">26</span></a> Similar findings were observed in Europe&#44; where after comparing growth curves of infected and non-infected children for ten years&#44; it was concluded that HIV infection results in slower growth rates and that the differences increase with age&#46;<a class="elsevierStyleCrossRef" href="#bib0555"><span class="elsevierStyleSup">53</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">Younger children may show greater weight and height recovery after the start of cART&#46; Nachman et al&#46; reported in 2005 that children younger than two years of age had a higher height <span class="elsevierStyleItalic">Z</span>-score during therapy&#46;<a class="elsevierStyleCrossRef" href="#bib0535"><span class="elsevierStyleSup">49</span></a> Weight gain was also predominantly higher in younger patients&#46;<a class="elsevierStyleCrossRef" href="#bib0535"><span class="elsevierStyleSup">49</span></a> In 2013&#44; Shiau et al&#46; evaluated a four-year follow-up of 195 AIDS patients and showed that patients who started cART before 6 months of age showed a faster improvement in weight-age and height-age <span class="elsevierStyleItalic">Z</span>-scores than those who started therapy later&#46;<a class="elsevierStyleCrossRef" href="#bib0420"><span class="elsevierStyleSup">26</span></a> Therefore&#44; the earlier the cART is initiated&#44; the lower the growth deficit&#46;<a class="elsevierStyleCrossRefs" href="#bib0420"><span class="elsevierStyleSup">26&#44;37</span></a></p><p id="par0140" class="elsevierStylePara elsevierViewall">Another important finding indicated in the studies refers to the nutritional status before treatment&#44; as it can influence the anthropometric outcomes after the introduction of cART&#46; Bandyopadhyay and Bhattacharyya showed in 2008 that malnourished children have worse results in the evolution of weight-age and height-age <span class="elsevierStyleItalic">Z</span>-scores compared to those who started therapy under adequate nutritional conditions&#46;<a class="elsevierStyleCrossRef" href="#bib0510"><span class="elsevierStyleSup">44</span></a></p><p id="par0145" class="elsevierStylePara elsevierViewall">In the review&#44; one of the main limitations was the inclusion of many studies conducted in Africa&#44; where nutritional deficiency may indirectly influence growth control and may represent a bias in the use of cART&#46; Malnutrition and growth retardation occur early in HIV vertical transmission&#44; and the negative impact of chronic infection and nutritional deficiency on growth may be irreversible&#46;<a class="elsevierStyleCrossRef" href="#bib0450"><span class="elsevierStyleSup">32</span></a> However&#44; the lack of growth pattern improvement occurred in studies carried out during a short period of time&#46; For instance&#44; in the 2011 study by Devi et al&#46;&#44; who assessed 102 patients only in the first year of cART use&#46;<a class="elsevierStyleCrossRef" href="#bib0450"><span class="elsevierStyleSup">32</span></a></p><p id="par0150" class="elsevierStylePara elsevierViewall">Furthermore&#44; the review did not compare the impact of different combined antiretroviral therapies with each other&#46; Furthermore&#44; it was not possible to analyze growth by age group&#46; None of the studies compared groups undergoing cART&#44; with and without virologic failure&#44; to assess growth&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Some studies have also highlighted the need to assess drug interactions in children and the potential adverse effects of cART on metabolism&#44; but studies are still scarce in this age group&#46; It is noteworthy that the possible metabolic effects of cART include insulin resistance&#44; dyslipidemia&#44; hyperlactatemia&#44; and that such changes may lead to an increased risk for cardiovascular diseases and diabetes&#46; The elevation of total cholesterol and lipodystrophy associated with the use of cART remains a challenge in the treatment of these patients&#46; Factors associated with children&#39;s adherence to cART showed that low adherence was strongly associated with the caregivers&#8217; profile &#40;low level of schooling and&#47;or degree of poverty&#41;&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Based on the data described herein&#44; the possible adverse effects of cART do not outweigh its benefits in terms of weight and height development&#44; morbidity&#44; and mortality in HIV-infected children&#46; cART is known to play a role in the improvement of viral and immunological markers and may influence the growth of HIV-infected children&#46; However&#44; the increase in anthropometric markers &#40;weight and height&#41; did not normalize the growth when compared to the healthy population&#46; The earlier the diagnosis of the HIV infection and&#44; concurrently&#44; of malnutrition and the initiation of cART&#44; the lower the growth deficit when compared to healthy children&#46; Patients with AIDS and without previous treatment for antiretroviral therapy show better anthropometric response to cART than previously treated patients&#46; However&#44; unfavorable socioeconomic and intrafamilial conditions influence treatment adherence&#44; representing a limiting factor for more significant and long-lasting results of the use of cART in HIV infection treatment&#46; Finally&#44; mainly in countries with low economic resources to quantify the viral load&#44; the improvement of anthropometric data during the use of cART as a parameter of therapeutic efficacy is more evident&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Funding</span><p id="par0165" class="elsevierStylePara elsevierViewall">FALM&#44; research support provided by <span class="elsevierStyleGrantSponsor" id="gs1">Funda&#231;&#227;o de Amparo &#224; Pesquisa do Estado de S&#227;o Paulo</span> &#8211; post-doctoral fellowship &#40;&#35; <span class="elsevierStyleGrantNumber" refid="gs1">2015&#47;12858-5</span>&#41;&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conflicts of interest</span><p id="par0170" class="elsevierStylePara elsevierViewall">The authors declare no conflicts of interest&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objectives</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Human immunodeficiency virus infection can result in the early impairment of anthropometric indicators in children and adolescents&#46; However&#44; combined antiretroviral therapy has improved&#44; in addition to the immune response and viral infection&#44; the weight and height development in infected individuals&#46; Therefore&#44; the objective was to evaluate the effect of combined antiretroviral on the growth development of human immunodeficiency virus infected children and adolescents&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Source of data</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A systematic review was performed&#46; In the study&#44; the PRISMA &#40;Preferred Reporting Items for Systematic Reviews and Meta-Analyses&#41; strategy was used as the eligibility criterion&#46; The MEDLINE-PubMed and LILACS databases were searched using these descriptors&#58; HIV&#44; children&#44; growth&#44; antiretroviral therapy&#46; The objective was defined by the population&#44; intervention&#44; comparison&#47;control&#44; and outcome &#40;PICO&#41; technique&#46; Inclusion and exclusion criteria were applied for study selection&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Synthesis of data</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Of the 549 studies indexed in MEDLINE-PubMed and LILACS&#44; 73 were read in full&#44; and 44 were included in the review &#40;33 showed a positive impact of combined antiretroviral therapy on weight&#47;height development&#44; ten on weight gain&#44; and one on height gain in children and adolescents infected with human immunodeficiency virus&#41;&#46; However&#44; the increase in growth was not enough to normalize the height of infected children when compared to children of the same age and gender without human immunodeficiency virus infection&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Combined antiretroviral therapy&#44; which is known to play a role in the improvement of viral and immunological markers&#44; may influence in the weight and height development in children infected with human immunodeficiency virus&#46; The earlier the infection diagnosis and&#44; concomitantly&#44; of malnutrition and the start of combined antiretroviral therapy&#44; the lower the growth impairment when compared to healthy children&#46;</p></span>"
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      "pt" => array:3 [
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivos</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">A infec&#231;&#227;o pelo v&#237;rus da imunodefici&#234;ncia humana pode comprometer&#44; precocemente&#44; os indicadores antropom&#233;tricos de crian&#231;as e adolescentes&#46; No entanto&#44; a terapia antirretroviral combinada tem melhorado&#44; al&#233;m da resposta imunol&#243;gica e da infec&#231;&#227;o viral&#44; o ganho p&#244;ndero-estatural dos infectados&#46; Dessa forma&#44; nosso objetivo foi avaliar o efeito da terapia antirretroviral combinada no crescimento&#44; de crian&#231;as e adolescentes&#44; infectadas pelo v&#237;rus da imunodefici&#234;ncia humana&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Fonte dos dados</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Foi realizada uma revis&#227;o sistem&#225;tica&#46; No estudo&#44; adotou-se como crit&#233;rio de elegibilidade dos artigos&#44; a estrat&#233;gia PRISMA &#40;<span class="elsevierStyleItalic">preferred reporting items for systematic reviews and meta-analyses</span>&#41;&#46; Foram consultadas as bases de dados MEDLINE-PubMed e LILACS pelos descritores&#58; HIV &#40;<span class="elsevierStyleItalic">v&#237;rus da imunodefici&#234;ncia humana&#41;</span>&#44; <span class="elsevierStyleItalic">children</span>&#44; <span class="elsevierStyleItalic">growth</span>&#44; <span class="elsevierStyleItalic">antiretroviral therapy</span>&#46; O objetivo foi definido pela estrat&#233;gia PICO &#40;<span class="elsevierStyleItalic">population</span>&#44; <span class="elsevierStyleItalic">intervention</span>&#44; <span class="elsevierStyleItalic">comparison</span>&#47;<span class="elsevierStyleItalic">control</span>&#44; <span class="elsevierStyleItalic">outcome</span>&#41;&#46; Crit&#233;rios de inclus&#227;o e exclus&#227;o foram aplicados na sele&#231;&#227;o dos estudos&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">S&#237;ntese dos dados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Dos 549 estudos indexados no MEDLINE-PubMed e LILACS&#44; 73 foram lidos na &#237;ntegra &#8211; 44 inclu&#237;dos na revis&#227;o &#40;33 demonstraram impacto positivo da terapia antirretroviral combinada no ganho p&#244;ndero-estatural&#44; dez no ganho de peso e um no de estatura&#44; em crian&#231;as e adolescentes&#44; infectados com v&#237;rus da imunodefici&#234;ncia humana&#41;&#46; No entanto&#44; o incremento no crescimento n&#227;o foi o suficiente para normalizar a estatura de crian&#231;as infectadas&#44; quando comparado com crian&#231;as da mesma idade e sexo&#44; sem infec&#231;&#227;o pelo v&#237;rus da imunodefici&#234;ncia humana&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclus&#245;es</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">A terapia antirretroviral combinada que&#44; conhecidamente&#44; atua na melhora de marcadores virais e imunol&#243;gicos&#44; pode influenciar no ganho p&#244;ndero-estatural de crian&#231;as infectadas com v&#237;rus da imunodefici&#234;ncia humana&#46; Quanto mais precoce o diagn&#243;stico da infec&#231;&#227;o e&#44; concomitante&#44; desnutri&#231;&#227;o e in&#237;cio da terapia antirretroviral combinada&#44; menores ser&#227;o os preju&#237;zos no crescimento&#44; quando comparado &#224;s crian&#231;as saud&#225;veis&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Objetivos"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Fonte dos dados"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "S&#237;ntese dos dados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclus&#245;es"
          ]
        ]
      ]
    ]
    "NotaPie" => array:2 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0020">Please cite this article as&#58; Golucci AP&#44; Marson FA&#44; Valente MF&#44; Branco MM&#44; Prado CC&#44; Nogueira RJ&#46; Influence of AIDS antiretroviral therapy on the growth pattern&#46; J Pediatr &#40;Rio J&#41;&#46; 2019&#59;95&#58;7&#8211;17&#46;</p>"
      ]
      1 => array:2 [
        "etiqueta" => "&#9734;&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0025">Study conducted at the Faculdade de Ci&#234;ncias M&#233;dicas&#44; Universidade Estadual de Campinas&#44; Campinas&#44; SP&#44; Brazil&#46;</p>"
      ]
    ]
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        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
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        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Flow diagram of article selection used in the systematic review&#46; LILACS&#44; Latin American and Caribbean Literature in Health Sciences&#59; MEDLINE-PubMed&#44; Medical Literature Analysis and Retrieval System Online &#8211; Public Medline&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
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        "descripcion" => array:1 [
          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Outcome associated with the growth related to the use of cART in children and adolescents infected by HIV&#46; cART&#44; combined antiretroviral therapy&#59; HIV&#44; human immunodeficiency virus&#59; CD4<span class="elsevierStyleSup">&#43;</span> TL&#44; CD4<span class="elsevierStyleSup">&#43;</span> T lymphocytes&#46;</p>"
        ]
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      2 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
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            "rol" => "short"
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">USA&#44; United States of America&#59; DR&#44; degree of recommendation&#59; LE&#44; level of evidence&#59; BMI&#44; body mass index&#59; CD4<span class="elsevierStyleSup">&#43;</span> TL&#44; CD4<span class="elsevierStyleSup">&#43;</span> T lymphocytes&#59; HAART&#44; highly-active antiretroviral therapy&#59; cART&#44; combined antiretroviral therapy&#46;</p>"
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              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Study &#40;year&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Location&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Study design&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Subjects&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Main results&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">DR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">LE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Jesson et al&#46; &#40;2017&#41;<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">10</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Africa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Prospective cohort<br>6 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">158 children<br>1 to 15 years old&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Improvement in weight <span class="elsevierStyleItalic">Z</span>-score and anemia reduction&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ramteke et al&#46; &#40;2017&#41;<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">9</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Africa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Longitudinal cohort<br>1 year&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">553 children &#40;300 controls&#41;<br>4 to 9 years old&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Improvement in weight and height <span class="elsevierStyleItalic">Z</span>-scores&#46; However&#44; weight and height were not within the normality parameters when compared with the control group&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Cames et al&#46; &#40;2017&#41;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">8</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Senegal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Prospective Cohort<br>2 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">244 children<br>2 to 16 years old&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Improvement in height <span class="elsevierStyleItalic">Z</span>-score&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ebissa et al&#46; &#40;2016&#41;<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">17</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ethiopia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Retrospective Cohort<br>2 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">556 children<br>1 to 10 years old&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Improvement in weight and height <span class="elsevierStyleItalic">Z</span>-scores and increase of CD4<span class="elsevierStyleSup">&#43;</span> TL lymphocytes<br>The effect was greater in underweight children&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Achan et al&#46; &#40;2016&#41;<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">18</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Africa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Randomized trial<br>3 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">129 children<br>2 months to 6 years old&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Improvement in height and weight <span class="elsevierStyleItalic">Z</span>-scores&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hu et al&#46; &#40;2016&#41;<a class="elsevierStyleCrossRef" href="#bib0385"><span class="elsevierStyleSup">19</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">China&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Retrospective Cohort<br>2 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">744 children<br>0 to 15 years old&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Improvement in weight and height <span class="elsevierStyleItalic">Z</span>-scores&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Feucht et al&#46; &#40;2016&#41;<a class="elsevierStyleCrossRef" href="#bib0390"><span class="elsevierStyleSup">20</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">South Africa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Observational cohort<br>3 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">159 children<br>Less than 5 years old&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Improvement in weight and BMI <span class="elsevierStyleItalic">Z</span>-scores in the first 12 months&#44; and in the height <span class="elsevierStyleItalic">Z</span>-score over 3 years of follow-up&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Schomaker et al&#46; &#40;2016&#41;<a class="elsevierStyleCrossRef" href="#bib0395"><span class="elsevierStyleSup">21</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Africa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Prospective cohort<br>3 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5826 children<br>2 to 5 years old&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Improvement in weight and height <span class="elsevierStyleItalic">Z</span>-scores and increase in CD4<span class="elsevierStyleSup">&#43;</span> TL levels&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Tekleab et al&#46; &#40;2016&#41;<a class="elsevierStyleCrossRef" href="#bib0400"><span class="elsevierStyleSup">22</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ethiopia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Prospective<br>3 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">202 children<br>2 to 5 years old&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Improvement in weight and height <span class="elsevierStyleItalic">Z</span>-scores&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2C&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Chattopadhyay et al&#46; &#40;2016&#41;<a class="elsevierStyleCrossRef" href="#bib0405"><span class="elsevierStyleSup">23</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">India&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cross-sectional<br>1 year&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">56 children<br>&#40;60 controls&#41;<br>2 to 10 years old&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Improvement in weight and height <span class="elsevierStyleItalic">Z</span>-scores&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Yotebieng et al&#46; &#40;2015&#41;<a class="elsevierStyleCrossRef" href="#bib0410"><span class="elsevierStyleSup">24</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Africa and<br>Asia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Retrospective<br>2 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7173 children<br>0 to 10 years old&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Improvement in weight-age <span class="elsevierStyleItalic">Z</span>-scores&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Kariminia et al&#46; &#40;2014&#41;<a class="elsevierStyleCrossRef" href="#bib0415"><span class="elsevierStyleSup">25</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Asia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Retrospective cohort<br>9 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2608 patients<br>0 to 15 years old&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Improvement in weight and height <span class="elsevierStyleItalic">Z</span>-scores&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Shiau et al&#46; &#40;2013&#41;<a class="elsevierStyleCrossRef" href="#bib0420"><span class="elsevierStyleSup">26</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">South Africa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Prospective<br>4 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">195 patients<br>0 to 2 years old&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Children who started cART before 6 months of age showed a faster improvement in weight and height <span class="elsevierStyleItalic">Z</span>-scores when compared to those that started the therapy later&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Chhagan et al&#46; &#40;2012&#41;<a class="elsevierStyleCrossRef" href="#bib0425"><span class="elsevierStyleSup">27</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Africa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Prospective<br>2 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">151<br>prepubertal children&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Improvement in weight and height <span class="elsevierStyleItalic">Z</span>-scores&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Gsponer et al&#46; &#40;2012&#41;<a class="elsevierStyleCrossRef" href="#bib0430"><span class="elsevierStyleSup">28</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Africa and<br>South Africa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Retrospective cohort&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">17&#44;990 patients<br>0 to 10 years old&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Improvement of weight and height <span class="elsevierStyleItalic">Z</span>-scores&#46; However&#44; the weight and height for the parameters within the normality curve for age were not reached&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Sutcliffe et al&#46; &#40;2011&#41;<a class="elsevierStyleCrossRef" href="#bib0435"><span class="elsevierStyleSup">29</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Zambia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Prospective cohort<br>2 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">193 patients<br>0 to 16 years old&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Improvement in weight and height <span class="elsevierStyleItalic">Z</span>-scores&#46; The effect was higher in underweight children&#44; and the lower height <span class="elsevierStyleItalic">Z</span>-score occurred in children older than 5 years&#46; After 2 years of treatment&#44; a large proportion of the children remained below weight and height for age&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">McGratha et al&#46; &#40;2011&#41;<a class="elsevierStyleCrossRef" href="#bib0440"><span class="elsevierStyleSup">30</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Kenya&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Prospective cohort<br>4 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">173 patients<br>0 to 10 years old&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Improvement in weight for age <span class="elsevierStyleItalic">Z</span>-score&#44; which was higher in children under 6 years&#46; There was no improvement in height <span class="elsevierStyleItalic">Z</span>-score&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Diniz et al&#46; &#40;2011&#41;<a class="elsevierStyleCrossRef" href="#bib0445"><span class="elsevierStyleSup">31</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Brazil&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Retrospective<br>3 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">196 patients<br>0 to 12 years old&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Better immune response and weight and height <span class="elsevierStyleItalic">Z</span>-scores were observed at the end of the follow-up&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Devi et al&#46; &#40;2011&#41;<a class="elsevierStyleCrossRef" href="#bib0450"><span class="elsevierStyleSup">32</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">India&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Prospective<br>1 year&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">102 patients<br>Mean age<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>74 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">In the first year of cART&#44; there was improvement in the immune response and weight <span class="elsevierStyleItalic">Z</span>-score&#44; but not height <span class="elsevierStyleItalic">Z</span>-score&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Naidoo et al&#46; &#40;2010&#41;<a class="elsevierStyleCrossRef" href="#bib0455"><span class="elsevierStyleSup">33</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">South Africa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Retrospective<br>8 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">120 children&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Improvement in weight and height <span class="elsevierStyleItalic">Z</span>-scores&#46; There was no effect on the height of children with severe malnutrition&#46; There was an increase in CD4<span class="elsevierStyleSup">&#43;</span> TL lymphocytes and a reduction in viral load&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2C&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Chantry et al&#46; &#40;2010&#41;<a class="elsevierStyleCrossRef" href="#bib0460"><span class="elsevierStyleSup">34</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">USA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Prospective&#47;cohort &#8211; 48 weeks&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">97 patients &#8211; 1 month to 13 years old &#40;incomplete&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Individuals starting or switching to cART were compared to the control group &#40;HIV-exposed but uninfected children and demographic and anthropometric data from an American study&#41;&#46; There was improvement in weight and height <span class="elsevierStyleItalic">Z</span>-scores&#44; but no change in BMI <span class="elsevierStyleItalic">Z</span>-score&#46; However&#44; weight and height were lower than those of the healthy population&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Yotebieng et al&#46; &#40;2010&#41;<a class="elsevierStyleCrossRef" href="#bib0465"><span class="elsevierStyleSup">35</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">South Africa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Prospective cohort &#8211; 4 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1394 patients<br>0 to 15 years old&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Improvement in weight <span class="elsevierStyleItalic">Z</span>-score&#44; but no change in height <span class="elsevierStyleItalic">Z</span>-score&#46; Additionally&#44; there was an improvement in CD4<span class="elsevierStyleSup">&#43;</span> TL count&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Weigel et al&#46; &#40;2010&#41;<a class="elsevierStyleCrossRef" href="#bib0470"><span class="elsevierStyleSup">36</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Malawi&#44; Africa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Prospective &#8211; 24 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">307 patients younger than 15 years old&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">There was an association between immunological response and weight and height <span class="elsevierStyleItalic">Z</span>-score improvement at the end of the follow-up&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2C&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Musoke et al&#46; &#40;2010&#41;<a class="elsevierStyleCrossRef" href="#bib0475"><span class="elsevierStyleSup">37</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Uganda&#44; Africa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Prospective &#8211; 48 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">130 patients<br>6 months to 12 years old&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Increased weight and height <span class="elsevierStyleItalic">Z</span>-scores&#44; with treatment&#44; especially in individuals who started the therapy at a younger age&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Aurpibul et al&#46; &#40;2009&#41;<a class="elsevierStyleCrossRef" href="#bib0480"><span class="elsevierStyleSup">38</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Thailand&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cohort &#8211; 5 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">225 patients<br>0 to 15 years old&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Compared with anthropometric reference data for Thai children&#44; with no control group&#46; There was a positive effect on weight and height <span class="elsevierStyleItalic">Z</span>-scores&#46; At the same time&#44; there was an increase in CD4<span class="elsevierStyleSup">&#43;</span> TL count&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Davies et al&#46; &#40;2009&#41;<a class="elsevierStyleCrossRef" href="#bib0485"><span class="elsevierStyleSup">39</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">South Africa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Prospective cohort &#8211; 9 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6078 patients<br>0 to 16 years old&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Improvement in weight and height <span class="elsevierStyleItalic">Z</span>-scores&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Kabue et al&#46; &#40;2008&#41;<a class="elsevierStyleCrossRef" href="#bib0490"><span class="elsevierStyleSup">40</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Uganda&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Retrospective &#8211; 3 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">749 patients &#8211; 0 to 19 years old&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Improvement in weight-age and height-age <span class="elsevierStyleItalic">Z</span>-scores&#46; The viral or immunological response was not assessed&#46; Moreover&#44; the study does not specify the use of HAART&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Buonora et al&#46; &#40;2008&#41;<a class="elsevierStyleCrossRef" href="#bib0495"><span class="elsevierStyleSup">41</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Brazil&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Retrospective &#8211; 97 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">108 patients<br>10 to 20 years old&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Even with HAART&#44; height-age and weight-age <span class="elsevierStyleItalic">Z</span>-scores were lower than those of healthy individuals&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Kekitiinwa et al&#46; &#40;2008&#41;<a class="elsevierStyleCrossRef" href="#bib0500"><span class="elsevierStyleSup">42</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">United Kingdom&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Prospective &#8211; 12 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1458 children<br>Mean age 5 and 7&#46;6 years old&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Improvement in weight-age and height-age <span class="elsevierStyleItalic">Z</span>-scores&#44; especially in younger children&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Jaspan et al&#46; &#40;2008&#41;<a class="elsevierStyleCrossRef" href="#bib0505"><span class="elsevierStyleSup">43</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">South Africa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Retrospective cohort &#8211; 4 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">391 patients<br>9 to 59 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Improvement in weight <span class="elsevierStyleItalic">Z</span>-score&#44; but height was not evaluated&#46; Additionally&#44; increased CD4<span class="elsevierStyleSup">&#43;</span> TL levels were observed&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Bandyopadhyay and Bhattacharyya &#40;2008&#41;<a class="elsevierStyleCrossRef" href="#bib0510"><span class="elsevierStyleSup">44</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">India&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Prospective &#8211; 18 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">123<br>2 months to 8 years old&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Malnutrition before the start of cART might impair the outcome in nutritional parameters&#59; there was an improvement only in the weight <span class="elsevierStyleItalic">Z</span>-score&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Zhang et al&#46; &#40;2007&#41;<a class="elsevierStyleCrossRef" href="#bib0515"><span class="elsevierStyleSup">45</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">China&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Prospective &#8211; 12 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">83 children &#8211; 7 to 13 years old&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Improvement in weight and height <span class="elsevierStyleItalic">Z</span>-scores and the immunological response of patients&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Wamalwa et al&#46; &#40;2007&#41;<a class="elsevierStyleCrossRef" href="#bib0520"><span class="elsevierStyleSup">46</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Kenya&#44; Africa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Prospective &#8211; 9 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">67 children<br>18 months to 12 years old&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Improvement in weight-age and height-age <span class="elsevierStyleItalic">Z</span>-scores&#46; Additionally&#44; the clinical response and viral control showed better results with the use of HAART&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Song et al&#46; &#40;2007&#41;<a class="elsevierStyleCrossRef" href="#bib0525"><span class="elsevierStyleSup">47</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Kenya&#44; Africa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Retrospective &#8211; 1 year&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">29 children &#8211; Mean age<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>8&#46;5 years old&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Improvement in weight-age <span class="elsevierStyleItalic">Z</span>-score&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Guillen et al&#46; &#40;2007&#41;<a class="elsevierStyleCrossRef" href="#bib0530"><span class="elsevierStyleSup">48</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Spain&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Retrospective &#8211; 5 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">264 patients<br>0 to 18 years old&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Improvement in weight and height <span class="elsevierStyleItalic">Z</span>-scores and viral control in the first 5 years of cART&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Nachman et al&#46; &#40;2005&#41;<a class="elsevierStyleCrossRef" href="#bib0535"><span class="elsevierStyleSup">49</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">USA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Prospective &#8211; 2 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">192 children<br>4 months to 17 years old&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">HAART allowed an increase in weight-age <span class="elsevierStyleItalic">Z</span>-score at week 48 and height-age at week 96&#46; Younger children gained weight in less time&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Lodha et al&#46; &#40;2005&#41;<a class="elsevierStyleCrossRef" href="#bib0540"><span class="elsevierStyleSup">50</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">India&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Prospective &#8211; 6 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">48 children &#8211; mean age<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>5&#46;6 years old&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Improvement in weight-age <span class="elsevierStyleItalic">Z</span>-score during the 6-month period&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2C&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ghaffari et al&#46; &#40;2004&#41;<a class="elsevierStyleCrossRef" href="#bib0545"><span class="elsevierStyleSup">51</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">USA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Prospective &#8211; 2 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">40 children<br>2 to18 years old&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Better immune response and higher weight and height <span class="elsevierStyleItalic">Z</span>-scores at the end of follow-up&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Kline et al&#46; &#40;2004&#41;<a class="elsevierStyleCrossRef" href="#bib0550"><span class="elsevierStyleSup">52</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Romania&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Prospective &#8211; 67 weeks&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">452 children<br>0 to 18 years old&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Improvement in weight and height <span class="elsevierStyleItalic">Z</span>-scores and immunological response&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2C&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Newell et al&#46; &#40;2003&#41;<a class="elsevierStyleCrossRef" href="#bib0555"><span class="elsevierStyleSup">53</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Europa &#40;11 countries&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Prospective &#8211; 10 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1587 patients<br>0 to 10 years old&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Improvement in weight and height <span class="elsevierStyleItalic">Z</span>-scores with cART&#44; regardless of clinical classification&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Verwell et al&#46; &#40;2002&#41;<a class="elsevierStyleCrossRef" href="#bib0560"><span class="elsevierStyleSup">54</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Netherlands&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Prospective study&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">24 children &#8211; 4 months to 16 years old &#40;96 weeks of treatment&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No control group was included&#44; but rather reference curves from the Netherlands&#46; Improvement in weight and height <span class="elsevierStyleItalic">Z</span>-scores in patients with reduced viral load and BMI <span class="elsevierStyleItalic">Z</span>-score in patients with advanced stage of disease and malnutrition&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2C&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Nachman et al&#46; &#40;2002&#41;<a class="elsevierStyleCrossRef" href="#bib0565"><span class="elsevierStyleSup">55</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">USA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Prospective &#8211; 120 weeks&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">197 patients &#8211; 2 to 17 years old&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">It was found that the growth deficit increased over time&#44; even in the individuals with better viral load control&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Miller et al&#46; &#40;2001&#41;<a class="elsevierStyleCrossRef" href="#bib0570"><span class="elsevierStyleSup">56</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">USA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cohort &#8211; 3 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">67 patients &#8211; 0 to 3&#46;8 years old&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Control group was not included&#46; Improvement in weight and weight&#47;height <span class="elsevierStyleItalic">Z</span>-scores&#44; as well as reduction in viral load&#44; but there was no effect on height&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Buchacz et al&#46; &#40;2001&#41;<a class="elsevierStyleCrossRef" href="#bib0575"><span class="elsevierStyleSup">57</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">USA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Prospective &#8211; 3 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">906 patients &#8211; 3 months to 18 years old&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Improvement in weight and height <span class="elsevierStyleItalic">Z</span>-scores with cART containing protease inhibitor&#44; regardless of clinical classification&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Weight and height improvement&nbsp;\t\t\t\t\t\t\n
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              "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Ramteke et al&#46;&#44; 2017<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">9</span></a>&#59; Ebissa et al&#46;&#44; 2016<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">17</span></a>&#59; Achan et al&#46;&#44; 2016<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">18</span></a>&#59; Hu et al&#46;&#44; 2016<a class="elsevierStyleCrossRef" href="#bib0385"><span class="elsevierStyleSup">19</span></a>&#59; Feucht et al&#46;&#44; 2016<a class="elsevierStyleCrossRef" href="#bib0390"><span class="elsevierStyleSup">20</span></a>&#59; Schomaker et al&#46;&#44; 2016<a class="elsevierStyleCrossRef" href="#bib0395"><span class="elsevierStyleSup">21</span></a>&#59; Tekleab et al&#46;&#44; 2016<a class="elsevierStyleCrossRef" href="#bib0400"><span class="elsevierStyleSup">22</span></a>&#59; Chattopadhyay et al&#46;&#44; 2016<a class="elsevierStyleCrossRef" href="#bib0405"><span class="elsevierStyleSup">23</span></a>&#59; Kariminia et al&#46;&#44; 2014<a class="elsevierStyleCrossRef" href="#bib0415"><span class="elsevierStyleSup">25</span></a>&#59; Shiau et al&#46;&#44; 2013<a class="elsevierStyleCrossRef" href="#bib0420"><span class="elsevierStyleSup">26</span></a>&#59; Chhagan et al&#46;&#44; 2012<a class="elsevierStyleCrossRef" href="#bib0425"><span class="elsevierStyleSup">27</span></a>&#59; Gsponer et al&#46;&#44; 2012<a class="elsevierStyleCrossRef" href="#bib0430"><span class="elsevierStyleSup">28</span></a>&#59; Sutcliffe et al&#46;&#44; 2016<a class="elsevierStyleCrossRef" href="#bib0435"><span class="elsevierStyleSup">29</span></a>&#59; Diniz et al&#46;&#44; 2011<a class="elsevierStyleCrossRef" href="#bib0445"><span class="elsevierStyleSup">31</span></a>&#59; Naidoo et al&#46;&#44; 2010<a class="elsevierStyleCrossRef" href="#bib0455"><span class="elsevierStyleSup">33</span></a>&#59; Chantry et al&#46;&#44; 2010<a class="elsevierStyleCrossRef" href="#bib0460"><span class="elsevierStyleSup">34</span></a>&#59; Weigel et al&#46;&#44; 2010<a class="elsevierStyleCrossRef" href="#bib0470"><span class="elsevierStyleSup">36</span></a>&#59; Musoke et al&#46;&#44; 2010<a class="elsevierStyleCrossRef" href="#bib0475"><span class="elsevierStyleSup">37</span></a>&#59; Aurpibul et al&#46;&#44; 2009<a class="elsevierStyleCrossRef" href="#bib0480"><span class="elsevierStyleSup">38</span></a>&#59; Davies et al&#46;&#44; 2009<a class="elsevierStyleCrossRef" href="#bib0485"><span class="elsevierStyleSup">39</span></a>&#59; Kabue et al&#46;&#44; 2008<a class="elsevierStyleCrossRef" href="#bib0490"><span class="elsevierStyleSup">40</span></a>&#59; Buonora et al&#46;&#44; 2008<a class="elsevierStyleCrossRef" href="#bib0495"><span class="elsevierStyleSup">41</span></a>&#59; Kekitiinwa et al&#46;&#44; 2008<a class="elsevierStyleCrossRef" href="#bib0500"><span class="elsevierStyleSup">42</span></a>&#59; Zhang et al&#46;&#44; 2007<a class="elsevierStyleCrossRef" href="#bib0515"><span class="elsevierStyleSup">45</span></a>&#59; Wamalwa et al&#46;&#44; 2007<a class="elsevierStyleCrossRef" href="#bib0520"><span class="elsevierStyleSup">46</span></a>&#59; Guillen et al&#46;&#44; 2007<a class="elsevierStyleCrossRef" href="#bib0530"><span class="elsevierStyleSup">48</span></a>&#59; Nachman et al&#46;&#44; 2005<a class="elsevierStyleCrossRef" href="#bib0535"><span class="elsevierStyleSup">49</span></a>&#59; Ghaffari et al&#46;&#44; 2004<a class="elsevierStyleCrossRef" href="#bib0545"><span class="elsevierStyleSup">51</span></a>&#59; Kline et al&#46;&#44; 2004<a class="elsevierStyleCrossRef" href="#bib0550"><span class="elsevierStyleSup">52</span></a>&#59; Newell et al&#46;&#44; 2003<a class="elsevierStyleCrossRef" href="#bib0555"><span class="elsevierStyleSup">53</span></a>&#59; Verweel et al&#46;&#44; 2003<a class="elsevierStyleCrossRef" href="#bib0560"><span class="elsevierStyleSup">54</span></a>&#59; Miller et al&#46;&#44; 2001<a class="elsevierStyleCrossRef" href="#bib0570"><span class="elsevierStyleSup">56</span></a>&#59; Buchacz et al&#46;&#44; 2001&#46;<a class="elsevierStyleCrossRef" href="#bib0575"><span class="elsevierStyleSup">57</span></a></p>"
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          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Outcome related to weight&#47;height development in HIV-infected patients &#40;total number of infected individuals<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>51&#44;992 children and adolescents&#41;&#44; submitted to therapy with cART&#46;</p>"
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Article information

ISSN: 00217557
Original language: English

DOI:10.1016/j.jped.2018.02.006

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Year/Month	Html	Pdf	Total

2024 November	4	3	7
2024 October	20	36	56
2024 September	28	30	58
2024 August	37	41	78
2024 July	37	47	84
2024 June	24	14	38
2024 May	11	13	24
2024 April	27	22	49
2024 March	42	16	58
2024 February	22	23	45
2024 January	16	31	47
2023 December	16	17	33
2023 November	25	29	54
2023 October	32	26	58
2023 September	31	37	68
2023 August	19	13	32
2023 July	27	13	40
2023 June	40	13	53
2023 May	29	17	46
2023 April	43	5	48
2023 March	45	18	63
2023 February	21	13	34
2023 January	16	20	36
2022 December	43	20	63
2022 November	24	26	50
2022 October	37	30	67
2022 September	29	28	57
2022 August	27	30	57
2022 July	23	29	52
2022 June	20	25	45
2022 May	27	27	54
2022 April	64	34	98
2022 March	34	46	80
2022 February	35	26	61
2022 January	66	16	82
2021 December	16	26	42
2021 November	10	23	33
2021 October	7	23	30
2021 September	6	6	12
2021 August	9	8	17
2021 July	3	13	16
2021 June	5	8	13
2021 May	13	20	33
2021 April	11	34	45
2021 March	17	23	40
2021 February	5	20	25
2021 January	8	18	26
2020 December	11	20	31
2020 November	8	21	29
2020 October	5	8	13
2020 September	17	13	30
2020 August	3	4	7
2020 July	7	10	17
2020 June	1	7	8
2020 May	7	5	12
2020 April	5	18	23
2020 March	7	3	10
2020 February	8	15	23
2020 January	13	16	29
2019 December	9	8	17
2019 November	6	10	16
2019 October	13	13	26
2019 September	8	10	18
2019 August	14	11	25
2019 July	18	8	26
2019 June	12	14	26
2019 May	10	11	21
2019 April	19	9	28
2019 March	20	11	31
2019 February	24	15	39
2019 January	24	31	55
2018 December	21	5	26
2018 November	54	7	61
2018 October	217	21	238
2018 September	90	9	99
2018 August	5	4	9
2018 July	5	7	12
2018 June	9	4	13
2018 May	0	11	11

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