Elsevier

The Journal of Pediatrics

Volume 162, Issue 6, June 2013, Pages 1138-1145.e2
The Journal of Pediatrics

Original Article
Initiation of Antiretroviral Therapy Before 6 Months of Age is Associated with Faster Growth Recovery in South African Children Perinatally Infected with Human Immunodeficiency Virus

https://doi.org/10.1016/j.jpeds.2012.11.025Get rights and content

Objective

To describe the effects of age at antiretroviral therapy (ART) initiation on growth outcomes among children infected with HIV followed for 48 months after treatment initiation.

Study design

This secondary analysis describes anthropometric changes in children infected with HIV in Johannesburg, South Africa who initiated ritonavir-boosted lopinavir-based ART before 24 months of age and were randomized to continue ritonavir-boosted lopinavir or to receive nevirapine after achieving and maintaining virologic suppression. Weight, height, and head circumference were measured at visits over 48 months post-ART initiation. Growth patterns including weight-for-age z-scores (WAZs), height-for-age z-scores, body mass index-for-age z-scores, and head circumference for age z-score were compared between children initiating ART <6 months, 6-12 months, and 12-24 months of age.

Results

A total of 195 children (mean ± SD age 10.7 ± 5.9 months), including 54 (27.7%) <6 months, 69 (35.4%) 6-12 months, and 72 (36.9%) 12-24 months of age at ART initiation, were evaluated. In the first 12 months on treatment, children <6 months of age at ART initiation experienced more rapid improvement in WAZ (1.98 vs 1.44, P = .084) and head circumference for age z-score (1.24 vs 0.45, P = .004) than children who initiated ART between 12-24 months of age. By 48 months on ART, growth outcomes were similar, regardless of age at ART initiation. WAZ approached population norms by 12 months on ART. Although improving, height-for-age z-scores remained on average 1.0 z-score below population norms at 48 months of therapy.

Conclusions

Initiation of ART before 6 months of age results in more rapid growth recovery in children infected with HIV. These data provide further evidence for the importance of prompt diagnosis and early initiation of ART for infants infected with HIV.

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)

  • F. Steiner et al.

    Growth in human immunodeficiency virus type 1-infected children treated with protease inhibitors

    Eur J Pediatr

    (2001)
  • WHO. Towards Universal Access: Scaling up priority HIV/AIDS interventions in the health sector. Available at:...
  • M.M. Kabue et al.

    Growth in HIV-infected children receiving antiretroviral therapy at a pediatric infectious diseases clinic in Uganda

    AIDS Patient Care STDS

    (2008)
  • C.J. McGrath et al.

    Younger age at HAART initiation is associated with more rapid growth reconstitution

    AIDS

    (2011)
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    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.

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