Original ArticleInitiation of Antiretroviral Therapy Before 6 Months of Age is Associated with Faster Growth Recovery in South African Children Perinatally Infected with Human Immunodeficiency Virus
Section snippets
Methods
We performed a secondary data analysis of anthropometric changes in children infected with HIV followed prospectively through 48 months of therapy as part of a clinical trial (ClinicalTrials.gov: NCT00117728) from ART initiation. The analysis evaluates the effect of age at ART initiation on growth outcomes. The data were collected as a part of a randomized trial that assessed the reuse of nevirapine (NVP) in children who previously were exposed to single-dose NVP prophylaxis at birth and who
Pretreatment Characteristics
Of the 195 children infected with HIV included in the analysis, 99 were randomized to continue on LPV/r and 96 to begin NVP. By the end of the study, 156 children (including 85 continued on LPV/r and 71 switched to NVP) completed extended follow-up, 6 children died, 28 were lost to follow-up, and 5 transferred out of the study. Total observed time on ART ranged from 6.4 months to 68.3 months, with a median of 47.6 months and mean of 46.1 ± 12.7 months.
Pretreatment characteristics of the 195
Discussion
In this study of South African children infected with HIV initiated on ART before 24 months of age and maintained on therapy with adequate virologic and immunologic response, WAZ, HAZ, BAZ, and HCAZ all improved considerably following treatment initiation. Early rapid weight gain was most pronounced among children started on ART during the first 6 months of life. A similar pattern in statural growth also was seen following some inconsistencies in the initial 6 months on ART. Growth benefits
References (29)
- et al.
Natural history of somatic growth in infants born to women infected by human immunodeficiency virus. Women and Infants Transmission Study Group
J Pediatr
(1996) - et al.
Switching children previously exposed to nevirapine to nevirapine-based treatment after initial suppression with a protease-inhibitor-based regimen: long-term follow-up of a randomised, open-label trial
Lancet Infect Dis
(2012) - et al.
Undernutrition as an underlying cause of child deaths associated with diarrhea, pneumonia, malaria, and measles
Am J Clin Nutr
(2004) - et al.
Growth in early childhood in a cohort of children born to HIV-1-infected women from Durban, South Africa
Ann Trop Paediatr
(2001) - et al.
Longitudinal growth during the first 2 years of life in children born to HIV-infected mothers in Malawi, Africa
Pediatr AIDS HIV Infect
(1996) - et al.
Growth failure as a prognostic indicator of mortality in pediatric HIV infection
Pediatrics
(1997) - et al.
Impact of protease inhibitor-containing combination antiretroviral therapies on height and weight growth in HIV-infected children
Pediatrics
(2001) - et al.
Impact on weight and height with the use of HAART in HIV-infected children
Pediatr Infect Dis J
(2007) - et al.
Treatment with highly active antiretroviral therapy in human immunodeficiency virus type 1-infected children is associated with a sustained effect on growth
Pediatrics
(2002) - et al.
Growth of human immunodeficiency virus-infected children receiving highly active antiretroviral therapy
Pediatr Infect Dis J
(2005)
Growth in human immunodeficiency virus type 1-infected children treated with protease inhibitors
Eur J Pediatr
Growth in HIV-infected children receiving antiretroviral therapy at a pediatric infectious diseases clinic in Uganda
AIDS Patient Care STDS
Younger age at HAART initiation is associated with more rapid growth reconstitution
AIDS
Cited by (43)
The clinical effect of point-of-care HIV diagnosis in infants: a systematic review and meta-analysis
2022, The LancetCitation Excerpt :Rapid antiretroviral therapy (ART) initiation can substantially reduce mortality and considerably improve virological control and viral reservoir size.2,4–9 Furthermore, earlier ART initiation improves immune function and has neurodevelopmental and overall growth benefits.10–13 However, only 53% of HIV-positive children younger than 15 years worldwide were receiving ART in 2019.3
Influence of the antiretroviral therapy on the growth pattern of children and adolescents living with HIV/AIDS
2019, Jornal de PediatriaCitation Excerpt :Moreover, growth failure was more frequent in the late treatment group. A study36 carried out in South Africa evaluated the effect of the age at ART initiation on growth, concluding that the start of ART before 6 months of age was associated with a better weight, height, and BMI recovery. Despite the improvement, the height Z-score did not reach the normal population values.
Influence of AIDS antiretroviral therapy on the growth pattern
2019, Jornal de PediatriaCitation Excerpt :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.26 Therefore, the earlier the cART is initiated, the lower the growth deficit.26,37 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.
Associated factors of malnutrition status among children and adolescents living with HIV in Tanzania: Individual-level analysis and marginal effect estimation
2024, International Journal of STD and AIDSUpdates in the Approach to Pediatric HIV Care and Prevention
2023, Current Treatment Options in Pediatrics
Supported by the National Institute of Child Health and Human Development (HD 47177, HD 61255) and Secure the Future Foundation (RES 219). The authors declare no conflicts of interest.
Trial registered with ClinicalTrials.gov: NCT00117728.