Growth in Virologically Suppressed HIV Positive Children on Antiretroviral Therapy: Individual and Population-Level References
Identifieur interne : 003198 ( Ncbi/Curation ); précédent : 003197; suivant : 003199Growth in Virologically Suppressed HIV Positive Children on Antiretroviral Therapy: Individual and Population-Level References
Auteurs : Olivia Keiser [Suisse] ; Nello Blaser [Suisse] ; Mary-Ann Davies [Afrique du Sud] ; Patrick Wessa [Belgique] ; Brian Eley [Afrique du Sud] ; Harry Moultrie [Afrique du Sud] ; Helena Rabie [Afrique du Sud] ; Karl Technau [Afrique du Sud] ; James Ndirangu [Afrique du Sud] ; Daniela Garone [Afrique du Sud] ; Janet Giddy [Afrique du Sud] ; Ashraf Grimwood [Afrique du Sud] ; Thomas Gsponer [Suisse] ; Matthias Egger [Suisse, Afrique du Sud]Source :
- The Pediatric infectious disease journal [ 0891-3668 ] ; 2015.
Abstract
Combination antiretroviral therapy (ART) suppresses viral replication in HIV-infected children. The growth of virologically suppressed children on ART has not been well documented. We aimed to develop dynamic reference curves for weight-for-age z scores (WAZ) and height-for-age z scores (HAZ).
Children aged <11 years at ART initiation with continuously undetectable viral loads (<400 copies/ml) treated at seven South African ART programs with routine viral load monitoring were included. We used multilevel models to define trajectories of WAZ and HAZ up to 3 years and developed a web application to monitor trajectories in individual children.
A total of 4,876 children were followed for 7,407 person-years. Analyses were stratified by baseline z-scores and age, which were the most important predictors of growth response. The youngest children showed the most pronounced increase in weight and height initially but catch-up growth stagnated after 1–2 years. Three years after starting ART, WAZ ranged from −2.2 (95% Prediction interval −5.6 to 0.8) in children with baseline age >5 years and z-score <−3 to 0.0 (−2.7 to 2.4) in children with baseline age <2 years and WAZ >−1. For HAZ the corresponding range was −2.3 (−4.9 to 0.3) in children with baseline age>5 years and z-score <−3 to 0.3 (−3.1 to 3.4) in children with baseline age 2–5 years and HAZ >−1.
We have developed an online tool to calculate reference trajectories in fully suppressed children. The web application could help to define ‘optimal’ growth response and identify children with treatment failure.
Url:
DOI: 10.1097/INF.0000000000000801
PubMed: 26192393
PubMed Central: 4570854
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<author><name sortKey="Moultrie, Harry" sort="Moultrie, Harry" uniqKey="Moultrie H" first="Harry" last="Moultrie">Harry Moultrie</name>
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<author><name sortKey="Rabie, Helena" sort="Rabie, Helena" uniqKey="Rabie H" first="Helena" last="Rabie">Helena Rabie</name>
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<author><name sortKey="Technau, Karl" sort="Technau, Karl" uniqKey="Technau K" first="Karl" last="Technau">Karl Technau</name>
<affiliation wicri:level="1"><nlm:aff id="A7">Empilweni Services and Research Unit (Rahima Moosa Mother and Child Hospital, Johannesburg) and University of Witwatersrand, Johannesburg, South Africa</nlm:aff>
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<wicri:regionArea>Empilweni Services and Research Unit (Rahima Moosa Mother and Child Hospital, Johannesburg) and University of Witwatersrand, Johannesburg</wicri:regionArea>
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<author><name sortKey="Ndirangu, James" sort="Ndirangu, James" uniqKey="Ndirangu J" first="James" last="Ndirangu">James Ndirangu</name>
<affiliation wicri:level="1"><nlm:aff id="A8">Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Somkhele, South Africa</nlm:aff>
<country xml:lang="fr">Afrique du Sud</country>
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<author><name sortKey="Garone, Daniela" sort="Garone, Daniela" uniqKey="Garone D" first="Daniela" last="Garone">Daniela Garone</name>
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<wicri:regionArea>Médecins Sans Frontières (MSF) South Africa, Khayelitsha, Cape Town</wicri:regionArea>
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<author><name sortKey="Giddy, Janet" sort="Giddy, Janet" uniqKey="Giddy J" first="Janet" last="Giddy">Janet Giddy</name>
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<author><name sortKey="Grimwood, Ashraf" sort="Grimwood, Ashraf" uniqKey="Grimwood A" first="Ashraf" last="Grimwood">Ashraf Grimwood</name>
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<country xml:lang="fr">Afrique du Sud</country>
<wicri:regionArea>Kheth’Impilo, Cape Town</wicri:regionArea>
<wicri:noRegion>Cape Town</wicri:noRegion>
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<author><name sortKey="Gsponer, Thomas" sort="Gsponer, Thomas" uniqKey="Gsponer T" first="Thomas" last="Gsponer">Thomas Gsponer</name>
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<wicri:regionArea>Institute of Social and Preventive Medicine (ISPM), University of Bern</wicri:regionArea>
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<author><name sortKey="Egger, Matthias" sort="Egger, Matthias" uniqKey="Egger M" first="Matthias" last="Egger">Matthias Egger</name>
<affiliation wicri:level="4"><nlm:aff id="A1">Institute of Social and Preventive Medicine (ISPM), University of Bern, Switzerland</nlm:aff>
<country xml:lang="fr">Suisse</country>
<wicri:regionArea>Institute of Social and Preventive Medicine (ISPM), University of Bern</wicri:regionArea>
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<affiliation wicri:level="1"><nlm:aff id="A2">School of Public Health and Family Medicine, University of Cape Town, South Africa</nlm:aff>
<country xml:lang="fr">Afrique du Sud</country>
<wicri:regionArea>School of Public Health and Family Medicine, University of Cape Town</wicri:regionArea>
<wicri:noRegion>University of Cape Town</wicri:noRegion>
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<series><title level="j">The Pediatric infectious disease journal</title>
<idno type="ISSN">0891-3668</idno>
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<imprint><date when="2015">2015</date>
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<front><div type="abstract" xml:lang="en"><sec id="S1"><title>Background</title>
<p id="P2">Combination antiretroviral therapy (ART) suppresses viral replication in HIV-infected children. The growth of virologically suppressed children on ART has not been well documented. We aimed to develop dynamic reference curves for weight-for-age z scores (WAZ) and height-for-age z scores (HAZ).</p>
</sec>
<sec id="S2"><title>Methods</title>
<p id="P3">Children aged <11 years at ART initiation with continuously undetectable viral loads (<400 copies/ml) treated at seven South African ART programs with routine viral load monitoring were included. We used multilevel models to define trajectories of WAZ and HAZ up to 3 years and developed a web application to monitor trajectories in individual children.</p>
</sec>
<sec id="S3"><title>Results</title>
<p id="P4">A total of 4,876 children were followed for 7,407 person-years. Analyses were stratified by baseline z-scores and age, which were the most important predictors of growth response. The youngest children showed the most pronounced increase in weight and height initially but catch-up growth stagnated after 1–2 years. Three years after starting ART, WAZ ranged from −2.2 (95% Prediction interval −5.6 to 0.8) in children with baseline age >5 years and z-score <−3 to 0.0 (−2.7 to 2.4) in children with baseline age <2 years and WAZ >−1. For HAZ the corresponding range was −2.3 (−4.9 to 0.3) in children with baseline age>5 years and z-score <−3 to 0.3 (−3.1 to 3.4) in children with baseline age 2–5 years and HAZ >−1.</p>
</sec>
<sec id="S4"><title>Conclusions</title>
<p id="P5">We have developed an online tool to calculate reference trajectories in fully suppressed children. The web application could help to define ‘optimal’ growth response and identify children with treatment failure.</p>
</sec>
</div>
</front>
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