Effect of baseline immune suppression on growth recovery in HIV positive South African children receiving antiretroviral treatment

Lydia Feinstein, Marcel Yotebieng, Harry Moultrie, Tammy Meyers, Annelies Van Rie

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

BACKGROUND: Growth failure is common among children infected with HIV. The degree of growth recovery and its determinants in children initiating combination antiretroviral therapy (cART) are not well understood. METHODS: We conducted a cohort study of children who initiated cART between 2004 and 2008 at a pediatric HIV clinic in Johannesburg, South Africa. To determine the effect of severe immunodeficiency at cART initiation on growth recovery (defined as attaining a z-score >-2), we generated Kaplan-Meier survival functions and fit a Cox proportional hazards model. In sensitivity analyses, we assessed selection bias due to loss to follow-up or death. RESULTS: Of the 2399 children who initiated cART, 71% presented with growth failure. Within 2 years of cART, only 81% of underweight children achieved normal weight, and 64% of stunted children achieved length/height recovery. Severe immunodeficiency at cART initiation was not associated with weight recovery [hazards ratio: 1.05, 95% CI: 0.83 to 1.32] or length/height recovery (hazards ratio: 1.06, 95% CI: 0.83 to 1.34) in overall analyses, and modification by baseline growth failure and age were modest. Older children and those with severe growth failure were less likely to achieve growth recovery, regardless of baseline immunodeficiency status. CONCLUSIONS: A substantial proportion of children fail to achieve growth recovery despite 2 years of cART. Our analysis did not support an association between baseline immunodeficiency and growth recovery. Younger age and less-severe growth failure at cART initiation are strong predictors of achieving growth recovery. These findings support early initiation of cART, before the presence of growth failure, and independent of level of immunodeficiency.

Original languageEnglish (US)
Pages (from-to)235-242
Number of pages8
JournalJournal of Acquired Immune Deficiency Syndromes
Volume61
Issue number2
DOIs
StatePublished - Oct 1 2012
Externally publishedYes

Fingerprint

HIV
Growth
Therapeutics
Weights and Measures
Selection Bias
Thinness
South Africa
Proportional Hazards Models
Cohort Studies
Pediatrics

Keywords

  • CD4
  • children
  • growth
  • height
  • HIV
  • weight

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)

Cite this

Effect of baseline immune suppression on growth recovery in HIV positive South African children receiving antiretroviral treatment. / Feinstein, Lydia; Yotebieng, Marcel; Moultrie, Harry; Meyers, Tammy; Van Rie, Annelies.

In: Journal of Acquired Immune Deficiency Syndromes, Vol. 61, No. 2, 01.10.2012, p. 235-242.

Research output: Contribution to journalArticle

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N2 - BACKGROUND: Growth failure is common among children infected with HIV. The degree of growth recovery and its determinants in children initiating combination antiretroviral therapy (cART) are not well understood. METHODS: We conducted a cohort study of children who initiated cART between 2004 and 2008 at a pediatric HIV clinic in Johannesburg, South Africa. To determine the effect of severe immunodeficiency at cART initiation on growth recovery (defined as attaining a z-score >-2), we generated Kaplan-Meier survival functions and fit a Cox proportional hazards model. In sensitivity analyses, we assessed selection bias due to loss to follow-up or death. RESULTS: Of the 2399 children who initiated cART, 71% presented with growth failure. Within 2 years of cART, only 81% of underweight children achieved normal weight, and 64% of stunted children achieved length/height recovery. Severe immunodeficiency at cART initiation was not associated with weight recovery [hazards ratio: 1.05, 95% CI: 0.83 to 1.32] or length/height recovery (hazards ratio: 1.06, 95% CI: 0.83 to 1.34) in overall analyses, and modification by baseline growth failure and age were modest. Older children and those with severe growth failure were less likely to achieve growth recovery, regardless of baseline immunodeficiency status. CONCLUSIONS: A substantial proportion of children fail to achieve growth recovery despite 2 years of cART. Our analysis did not support an association between baseline immunodeficiency and growth recovery. Younger age and less-severe growth failure at cART initiation are strong predictors of achieving growth recovery. These findings support early initiation of cART, before the presence of growth failure, and independent of level of immunodeficiency.

AB - BACKGROUND: Growth failure is common among children infected with HIV. The degree of growth recovery and its determinants in children initiating combination antiretroviral therapy (cART) are not well understood. METHODS: We conducted a cohort study of children who initiated cART between 2004 and 2008 at a pediatric HIV clinic in Johannesburg, South Africa. To determine the effect of severe immunodeficiency at cART initiation on growth recovery (defined as attaining a z-score >-2), we generated Kaplan-Meier survival functions and fit a Cox proportional hazards model. In sensitivity analyses, we assessed selection bias due to loss to follow-up or death. RESULTS: Of the 2399 children who initiated cART, 71% presented with growth failure. Within 2 years of cART, only 81% of underweight children achieved normal weight, and 64% of stunted children achieved length/height recovery. Severe immunodeficiency at cART initiation was not associated with weight recovery [hazards ratio: 1.05, 95% CI: 0.83 to 1.32] or length/height recovery (hazards ratio: 1.06, 95% CI: 0.83 to 1.34) in overall analyses, and modification by baseline growth failure and age were modest. Older children and those with severe growth failure were less likely to achieve growth recovery, regardless of baseline immunodeficiency status. CONCLUSIONS: A substantial proportion of children fail to achieve growth recovery despite 2 years of cART. Our analysis did not support an association between baseline immunodeficiency and growth recovery. Younger age and less-severe growth failure at cART initiation are strong predictors of achieving growth recovery. These findings support early initiation of cART, before the presence of growth failure, and independent of level of immunodeficiency.

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