Growth Patterns of HIV Infected Indian Children in Response to ART: A Clinic Based Cohort Study
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To describe catch-up growth after antiretroviral therapy (ART) initiation among children living with human immunodeficiency virus (CLHIV), attending a private clinic in India.
This is a retrospective analysis of data of CLHIV attending Prayas clinic, Pune, India. Height and weight z scores (HAZ, WAZ) were calculated using WHO growth charts. Catch-up growth post-ART was assessed using a mixed method model in cases where baseline and at least one subsequent follow-up HAZ/WAZ were available. STATA 12 was used for statistical analysis.
During 1998 to 2011, 466 children were enrolled (201 girls and 265 boys; median age = 7 y). A total of 302 children were ever started on ART; of which 73 and 76 children were included for analysis for catch up growth in WAZ and HAZ respectively. Median WAZ and HAZ increased from −2.14 to −1.34 (p = 0.007) and −2.42 to −1.94 (p = 0.34), respectively, 3 y post ART. Multivariable analysis using mixed model (adjusted for gender, guardianship, baseline age, baseline WAZ/HAZ, baseline and time varying WHO clinical stage) showed gains in WAZ (coef = 0.2, 95 % CI: −0.06 to 0.46) and HAZ (coef = 0.49, 95 % CI: 0.21 to 0.77) with time on ART. Lower baseline WAZ/HAZ and older age were associated with impaired catch-up growth. Children staying in institutions and with baseline advanced clinical stage showed higher gain in WAZ.
The prevalence of stunting and underweight was high at ART initiation. Sustained catch-up growth was seen with ART. The study highlights the benefit of early ART in achieving normal growth in CLHIV.
KeywordsHIV/AIDS HIV infected children Anti-retroviral therapy Catch up growth Growth failure
The authors thank the entire staff of the Prayas clinic for their efforts in maintaining the data which made this analysis possible.
RP had major contributions to conceptualization of the study, data cleaning and analysis and writing the paper. TD helped in data cleaning and analysis. BM and RM participated in study design and statistical analysis. PE and VK provided valuable inputs in refining the study design, and review of the manuscript. All authors read and approved the final manuscript. VK will act as guarantor for this paper.
Conflict of Interest
Source of Funding
The study was supported by Award Number D43TW006793 from the Fogarty International Center. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Fogarty International Center or the National Institutes of Health.
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