Anthropometric Improvement among HIV Infected Pre-School Children Following Initiation of First Line Anti-Retroviral Therapy: Implications for Follow Up
Identifieur interne : 002931 ( Pmc/Curation ); précédent : 002930; suivant : 002932Anthropometric Improvement among HIV Infected Pre-School Children Following Initiation of First Line Anti-Retroviral Therapy: Implications for Follow Up
Auteurs : Atnafu Mekonnen Tekleab [Éthiopie] ; Birkneh Tilahun Tadesse [Éthiopie] ; Ababi Zergaw Giref [Éthiopie] ; Damte Shimelis [Éthiopie] ; Meseret Gebre [Éthiopie]Source :
- PLoS ONE [ 1932-6203 ] ; 2016.
Abstract
Antiretroviral therapy (ART) is a lifesaving intervention for HIV infected children. There is a scarcity of data on immunological recovery and its relation with growth indicators among HIV infected young children. The current study aims to assess the pattern of anthropometric Z-score improvement following initiation of first-line ART among under-five children and the relationship between anthropometric Z-score improvement and immunologic recovery.
We included under-five children who were on first-line ART at five major hospitals in Addis Ababa, Ethiopia. We measured anthropometry and collected clinical and laboratory data at follow up, and we retrieved clinical and anthropometric data at ART initiation from records. Z-scores for each of the anthropometric indices were calculated based on WHO growth standards using ENA for SMART 2011 software. Linear regression was used to assess the relationship between time on ART and anthropometric Z-score improvement; and the relationship between anthropometric Z-score improvement and immunologic recovery. Multiple linear regression was used to assess the independent predictors of anthropometric Z-score change.
The median age of the participants was 4.1 (Interquartile range (IQR): 3.3–4.9) years. More than half (52.48%) were female. The median duration of follow up was 1.69 (IQR: 1.08–2.63) years. There was a significant improvement in all anthropometric indices at any follow up after initiation of first-line ART (underweight; 39.5% vs16.5%, stunting; 71.3% vs 62.9% and wasting; 16.3% vs 1.0%; p-value< 0.0001). There was an inverse relationship between improvement in weight for age Z-score (WAZ) and duration of ART (R2 = 0.04; F (1, 158); p = 0.013). Height for age Z-score (HAZ) both at the time of ART initiation and follow up has a positive linear relationship with CD4 percentage at follow up (Coef. = 1.92; R2 = 0.05; p-value = 0.002). Duration on ART (
There was a significant improvement in all anthropometric indices at any follow-up after initiation of first-line ART among under-five children. HAZ was linearly related with immunologic recovery following ART initiation. The findings indicate that anthropometric indices could be taken as proxy indicators of immunologic recovery for under-five children.
Url:
DOI: 10.1371/journal.pone.0167565
PubMed: 28030557
PubMed Central: 5193336
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<sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Anthropometric Improvement among HIV Infected Pre-School Children Following Initiation of First Line Anti-Retroviral Therapy: Implications for Follow Up</title>
<author><name sortKey="Tekleab, Atnafu Mekonnen" sort="Tekleab, Atnafu Mekonnen" uniqKey="Tekleab A" first="Atnafu Mekonnen" last="Tekleab">Atnafu Mekonnen Tekleab</name>
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<country xml:lang="fr">Éthiopie</country>
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<author><name sortKey="Tadesse, Birkneh Tilahun" sort="Tadesse, Birkneh Tilahun" uniqKey="Tadesse B" first="Birkneh Tilahun" last="Tadesse">Birkneh Tilahun Tadesse</name>
<affiliation wicri:level="1"><nlm:aff id="aff002"><addr-line>Hawassa University, Department of Pediatrics, Hawassa, Ethiopia</addr-line>
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<country xml:lang="fr">Éthiopie</country>
<wicri:regionArea>Hawassa University, Department of Pediatrics, Hawassa</wicri:regionArea>
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<author><name sortKey="Giref, Ababi Zergaw" sort="Giref, Ababi Zergaw" uniqKey="Giref A" first="Ababi Zergaw" last="Giref">Ababi Zergaw Giref</name>
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<author><name sortKey="Shimelis, Damte" sort="Shimelis, Damte" uniqKey="Shimelis D" first="Damte" last="Shimelis">Damte Shimelis</name>
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<country xml:lang="fr">Éthiopie</country>
<wicri:regionArea>Addis Ababa University, School of Medicine, Addis Ababa</wicri:regionArea>
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<author><name sortKey="Gebre, Meseret" sort="Gebre, Meseret" uniqKey="Gebre M" first="Meseret" last="Gebre">Meseret Gebre</name>
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<country xml:lang="fr">Éthiopie</country>
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<front><div type="abstract" xml:lang="en"><sec id="sec001"><title>Background</title>
<p>Antiretroviral therapy (ART) is a lifesaving intervention for HIV infected children. There is a scarcity of data on immunological recovery and its relation with growth indicators among HIV infected young children. The current study aims to assess the pattern of anthropometric Z-score improvement following initiation of first-line ART among under-five children and the relationship between anthropometric Z-score improvement and immunologic recovery.</p>
</sec>
<sec id="sec002"><title>Methods</title>
<p>We included under-five children who were on first-line ART at five major hospitals in Addis Ababa, Ethiopia. We measured anthropometry and collected clinical and laboratory data at follow up, and we retrieved clinical and anthropometric data at ART initiation from records. Z-scores for each of the anthropometric indices were calculated based on WHO growth standards using ENA for SMART 2011 software. Linear regression was used to assess the relationship between time on ART and anthropometric Z-score improvement; and the relationship between anthropometric Z-score improvement and immunologic recovery. Multiple linear regression was used to assess the independent predictors of anthropometric Z-score change.</p>
</sec>
<sec id="sec003"><title>Results</title>
<p>The median age of the participants was 4.1 (Interquartile range (IQR): 3.3–4.9) years. More than half (52.48%) were female. The median duration of follow up was 1.69 (IQR: 1.08–2.63) years. There was a significant improvement in all anthropometric indices at any follow up after initiation of first-line ART (underweight; 39.5% vs16.5%, stunting; 71.3% vs 62.9% and wasting; 16.3% vs 1.0%; p-value< 0.0001). There was an inverse relationship between improvement in weight for age Z-score (WAZ) and duration of ART (R<sup>2</sup>
= 0.04; F (1, 158); p = 0.013). Height for age Z-score (HAZ) both at the time of ART initiation and follow up has a positive linear relationship with CD4 percentage at follow up (Coef. = 1.92; R<sup>2</sup>
= 0.05; p-value = 0.002). Duration on ART (<italic>Std</italic>
. <italic>Err</italic>
. = 0.206, <italic>t</italic>
= -1.99, p-value = 0.049) and level of maternal education (<italic>Std</italic>
. <italic>Err</italic>
. = 0.290, <italic>t</italic>
= 2.64, p-value = 0.009) were the only independent predictors of the change in WAZ and change in HAZ at any follow up visit respectively.</p>
</sec>
<sec id="sec004"><title>Conclusion</title>
<p>There was a significant improvement in all anthropometric indices at any follow-up after initiation of first-line ART among under-five children. HAZ was linearly related with immunologic recovery following ART initiation. The findings indicate that anthropometric indices could be taken as proxy indicators of immunologic recovery for under-five children.</p>
</sec>
</div>
</front>
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</analytic>
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<pmc article-type="research-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">PLoS One</journal-id>
<journal-id journal-id-type="iso-abbrev">PLoS ONE</journal-id>
<journal-id journal-id-type="publisher-id">plos</journal-id>
<journal-id journal-id-type="pmc">plosone</journal-id>
<journal-title-group><journal-title>PLoS ONE</journal-title>
</journal-title-group>
<issn pub-type="epub">1932-6203</issn>
<publisher><publisher-name>Public Library of Science</publisher-name>
<publisher-loc>San Francisco, CA USA</publisher-loc>
</publisher>
</journal-meta>
<article-meta><article-id pub-id-type="pmid">28030557</article-id>
<article-id pub-id-type="pmc">5193336</article-id>
<article-id pub-id-type="doi">10.1371/journal.pone.0167565</article-id>
<article-id pub-id-type="publisher-id">PONE-D-16-15483</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject>
</subj-group>
<subj-group subj-group-type="Discipline-v3"><subject>Social Sciences</subject>
<subj-group><subject>Anthropology</subject>
<subj-group><subject>Physical Anthropology</subject>
<subj-group><subject>Anthropometry</subject>
</subj-group>
</subj-group>
</subj-group>
</subj-group>
<subj-group subj-group-type="Discipline-v3"><subject>Biology and Life Sciences</subject>
<subj-group><subject>Physical Anthropology</subject>
<subj-group><subject>Anthropometry</subject>
</subj-group>
</subj-group>
</subj-group>
<subj-group subj-group-type="Discipline-v3"><subject>Medicine and health sciences</subject>
<subj-group><subject>Infectious diseases</subject>
<subj-group><subject>Viral diseases</subject>
<subj-group><subject>HIV infections</subject>
</subj-group>
</subj-group>
</subj-group>
</subj-group>
<subj-group subj-group-type="Discipline-v3"><subject>People and Places</subject>
<subj-group><subject>Population Groupings</subject>
<subj-group><subject>Age Groups</subject>
<subj-group><subject>Children</subject>
</subj-group>
</subj-group>
</subj-group>
</subj-group>
<subj-group subj-group-type="Discipline-v3"><subject>People and Places</subject>
<subj-group><subject>Population Groupings</subject>
<subj-group><subject>Families</subject>
<subj-group><subject>Children</subject>
</subj-group>
</subj-group>
</subj-group>
</subj-group>
<subj-group subj-group-type="Discipline-v3"><subject>Biology and Life Sciences</subject>
<subj-group><subject>Nutrition</subject>
<subj-group><subject>Malnutrition</subject>
</subj-group>
</subj-group>
</subj-group>
<subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject>
<subj-group><subject>Nutrition</subject>
<subj-group><subject>Malnutrition</subject>
</subj-group>
</subj-group>
</subj-group>
<subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject>
<subj-group><subject>Pediatrics</subject>
<subj-group><subject>Pediatric Infections</subject>
</subj-group>
</subj-group>
</subj-group>
<subj-group subj-group-type="Discipline-v3"><subject>Medicine and health sciences</subject>
<subj-group><subject>Diagnostic medicine</subject>
<subj-group><subject>HIV diagnosis and management</subject>
</subj-group>
</subj-group>
</subj-group>
<subj-group subj-group-type="Discipline-v3"><subject>Biology and Life Sciences</subject>
<subj-group><subject>Immunology</subject>
<subj-group><subject>Vaccination and Immunization</subject>
<subj-group><subject>Antiviral Therapy</subject>
<subj-group><subject>Antiretroviral Therapy</subject>
</subj-group>
</subj-group>
</subj-group>
</subj-group>
</subj-group>
<subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject>
<subj-group><subject>Immunology</subject>
<subj-group><subject>Vaccination and Immunization</subject>
<subj-group><subject>Antiviral Therapy</subject>
<subj-group><subject>Antiretroviral Therapy</subject>
</subj-group>
</subj-group>
</subj-group>
</subj-group>
</subj-group>
<subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject>
<subj-group><subject>Public and Occupational Health</subject>
<subj-group><subject>Preventive Medicine</subject>
<subj-group><subject>Vaccination and Immunization</subject>
<subj-group><subject>Antiviral Therapy</subject>
<subj-group><subject>Antiretroviral Therapy</subject>
</subj-group>
</subj-group>
</subj-group>
</subj-group>
</subj-group>
</subj-group>
<subj-group subj-group-type="Discipline-v3"><subject>Research and Analysis Methods</subject>
<subj-group><subject>Mathematical and Statistical Techniques</subject>
<subj-group><subject>Statistical Methods</subject>
<subj-group><subject>Regression Analysis</subject>
<subj-group><subject>Linear Regression Analysis</subject>
</subj-group>
</subj-group>
</subj-group>
</subj-group>
</subj-group>
<subj-group subj-group-type="Discipline-v3"><subject>Physical Sciences</subject>
<subj-group><subject>Mathematics</subject>
<subj-group><subject>Statistics (Mathematics)</subject>
<subj-group><subject>Statistical Methods</subject>
<subj-group><subject>Regression Analysis</subject>
<subj-group><subject>Linear Regression Analysis</subject>
</subj-group>
</subj-group>
</subj-group>
</subj-group>
</subj-group>
</subj-group>
</article-categories>
<title-group><article-title>Anthropometric Improvement among HIV Infected Pre-School Children Following Initiation of First Line Anti-Retroviral Therapy: Implications for Follow Up</article-title>
<alt-title alt-title-type="running-head">Efficacy of ART in Pre-School Children</alt-title>
</title-group>
<contrib-group><contrib contrib-type="author"><name><surname>Tekleab</surname>
<given-names>Atnafu Mekonnen</given-names>
</name>
<xref ref-type="aff" rid="aff001"><sup>1</sup>
</xref>
</contrib>
<contrib contrib-type="author"><contrib-id authenticated="true" contrib-id-type="orcid">http://orcid.org/0000-0003-4005-8605</contrib-id>
<name><surname>Tadesse</surname>
<given-names>Birkneh Tilahun</given-names>
</name>
<xref ref-type="aff" rid="aff002"><sup>2</sup>
</xref>
<xref ref-type="corresp" rid="cor001">*</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Giref</surname>
<given-names>Ababi Zergaw</given-names>
</name>
<xref ref-type="aff" rid="aff003"><sup>3</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Shimelis</surname>
<given-names>Damte</given-names>
</name>
<xref ref-type="aff" rid="aff003"><sup>3</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Gebre</surname>
<given-names>Meseret</given-names>
</name>
<xref ref-type="aff" rid="aff004"><sup>4</sup>
</xref>
</contrib>
</contrib-group>
<aff id="aff001"><label>1</label>
<addr-line>St Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia</addr-line>
</aff>
<aff id="aff002"><label>2</label>
<addr-line>Hawassa University, Department of Pediatrics, Hawassa, Ethiopia</addr-line>
</aff>
<aff id="aff003"><label>3</label>
<addr-line>Addis Ababa University, School of Medicine, Addis Ababa, Ethiopia</addr-line>
</aff>
<aff id="aff004"><label>4</label>
<addr-line>ALERT Medical Center, Addis Ababa, Ethiopia</addr-line>
</aff>
<contrib-group><contrib contrib-type="editor"><name><surname>Beck</surname>
<given-names>Eduard J</given-names>
</name>
<role>Editor</role>
<xref ref-type="aff" rid="edit1"></xref>
</contrib>
</contrib-group>
<aff id="edit1"><addr-line>UNAIDS, GUYANA</addr-line>
</aff>
<author-notes><fn fn-type="COI-statement" id="coi001"><p><bold>Competing Interests: </bold>
The authors have declared that no competing interests exist.</p>
</fn>
<fn fn-type="con"><p><list list-type="simple"><list-item><p><bold>Conceptualization:</bold>
AMT BTT.</p>
</list-item>
<list-item><p><bold>Data curation:</bold>
AMT BTT.</p>
</list-item>
<list-item><p><bold>Formal analysis:</bold>
BTT AMT.</p>
</list-item>
<list-item><p><bold>Investigation:</bold>
AMT AZG DS MG.</p>
</list-item>
<list-item><p><bold>Methodology:</bold>
AMT BTT.</p>
</list-item>
<list-item><p><bold>Project administration:</bold>
AMT MG DS AZG.</p>
</list-item>
<list-item><p><bold>Resources:</bold>
AMT BTT AZG DS MG.</p>
</list-item>
<list-item><p><bold>Software:</bold>
BTT AMT.</p>
</list-item>
<list-item><p><bold>Supervision:</bold>
AMT DS AZG MG.</p>
</list-item>
<list-item><p><bold>Validation:</bold>
AMT BTT DS MG AZG.</p>
</list-item>
<list-item><p><bold>Visualization:</bold>
BTT AMT.</p>
</list-item>
<list-item><p><bold>Writing – original draft:</bold>
BTT AMT.</p>
</list-item>
<list-item><p><bold>Writing – review & editing:</bold>
BTT AMT MG DS AZG.</p>
</list-item>
</list>
</p>
</fn>
<corresp id="cor001">* E-mail: <email>birknehtilahun@gmail.com</email>
</corresp>
</author-notes>
<pub-date pub-type="epub"><day>28</day>
<month>12</month>
<year>2016</year>
</pub-date>
<pub-date pub-type="collection"><year>2016</year>
</pub-date>
<volume>11</volume>
<issue>12</issue>
<elocation-id>e0167565</elocation-id>
<history><date date-type="received"><day>17</day>
<month>4</month>
<year>2016</year>
</date>
<date date-type="accepted"><day>16</day>
<month>11</month>
<year>2016</year>
</date>
</history>
<permissions><copyright-statement>© 2016 Tekleab et al</copyright-statement>
<copyright-year>2016</copyright-year>
<copyright-holder>Tekleab et al</copyright-holder>
<license xlink:href="http://creativecommons.org/licenses/by/4.0/"><license-p>This is an open access article distributed under the terms of the <ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/4.0/">Creative Commons Attribution License</ext-link>
, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.</license-p>
</license>
</permissions>
<self-uri content-type="pdf" xlink:href="pone.0167565.pdf"></self-uri>
<abstract><sec id="sec001"><title>Background</title>
<p>Antiretroviral therapy (ART) is a lifesaving intervention for HIV infected children. There is a scarcity of data on immunological recovery and its relation with growth indicators among HIV infected young children. The current study aims to assess the pattern of anthropometric Z-score improvement following initiation of first-line ART among under-five children and the relationship between anthropometric Z-score improvement and immunologic recovery.</p>
</sec>
<sec id="sec002"><title>Methods</title>
<p>We included under-five children who were on first-line ART at five major hospitals in Addis Ababa, Ethiopia. We measured anthropometry and collected clinical and laboratory data at follow up, and we retrieved clinical and anthropometric data at ART initiation from records. Z-scores for each of the anthropometric indices were calculated based on WHO growth standards using ENA for SMART 2011 software. Linear regression was used to assess the relationship between time on ART and anthropometric Z-score improvement; and the relationship between anthropometric Z-score improvement and immunologic recovery. Multiple linear regression was used to assess the independent predictors of anthropometric Z-score change.</p>
</sec>
<sec id="sec003"><title>Results</title>
<p>The median age of the participants was 4.1 (Interquartile range (IQR): 3.3–4.9) years. More than half (52.48%) were female. The median duration of follow up was 1.69 (IQR: 1.08–2.63) years. There was a significant improvement in all anthropometric indices at any follow up after initiation of first-line ART (underweight; 39.5% vs16.5%, stunting; 71.3% vs 62.9% and wasting; 16.3% vs 1.0%; p-value< 0.0001). There was an inverse relationship between improvement in weight for age Z-score (WAZ) and duration of ART (R<sup>2</sup>
= 0.04; F (1, 158); p = 0.013). Height for age Z-score (HAZ) both at the time of ART initiation and follow up has a positive linear relationship with CD4 percentage at follow up (Coef. = 1.92; R<sup>2</sup>
= 0.05; p-value = 0.002). Duration on ART (<italic>Std</italic>
. <italic>Err</italic>
. = 0.206, <italic>t</italic>
= -1.99, p-value = 0.049) and level of maternal education (<italic>Std</italic>
. <italic>Err</italic>
. = 0.290, <italic>t</italic>
= 2.64, p-value = 0.009) were the only independent predictors of the change in WAZ and change in HAZ at any follow up visit respectively.</p>
</sec>
<sec id="sec004"><title>Conclusion</title>
<p>There was a significant improvement in all anthropometric indices at any follow-up after initiation of first-line ART among under-five children. HAZ was linearly related with immunologic recovery following ART initiation. The findings indicate that anthropometric indices could be taken as proxy indicators of immunologic recovery for under-five children.</p>
</sec>
</abstract>
<funding-group><funding-statement>The authors received no specific funding for this work.</funding-statement>
</funding-group>
<counts><fig-count count="4"></fig-count>
<table-count count="5"></table-count>
<page-count count="14"></page-count>
</counts>
<custom-meta-group><custom-meta id="data-availability"><meta-name>Data Availability</meta-name>
<meta-value>Due to concerns related to participant confidentiality, the data are available upon request. Interested researchers may contact Dr Birkneh Tilahun Tadesse at: <email>birknehtilahun@gmail.com</email>
, or Dr Atnafu Mekonnen Tekleab at: <email>atnemekonnen@yahoo.com</email>
.</meta-value>
</custom-meta>
</custom-meta-group>
</article-meta>
<notes><title>Data Availability</title>
<p>Due to concerns related to participant confidentiality, the data are available upon request. Interested researchers may contact Dr Birkneh Tilahun Tadesse at: <email>birknehtilahun@gmail.com</email>
, or Dr Atnafu Mekonnen Tekleab at: <email>atnemekonnen@yahoo.com</email>
.</p>
</notes>
</front>
</pmc>
</record>
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