Growth Patterns of HIV Infected Indian Children in Response to ART: A Clinic Based Cohort Study

• Published in: Indian journal of pediatrics 2015-06, Vol.82 (6), p.519-524
• Main Authors: Parchure, Ritu S., Kulkarni, Vinay V., Darak, Trupti S., Mhaskar, Rahul, Miladinovic, Branko, Emmanuel, Patricia J.
• Format: Article
• Language: English
• Subjects: Acquired Immunodeficiency Syndrome - epidemiology; Acquired Immunodeficiency Syndrome - etiology; Acquired Immunodeficiency Syndrome - physiopathology; Anthropometry - methods; Anti-Retroviral Agents - administration & dosage; Body Height; Body Weight; CD4 Lymphocyte Count - statistics & numerical data; Child; Early Medical Intervention; Female; Growth Charts; Growth Disorders - diagnosis; Growth Disorders - epidemiology; Growth Disorders - etiology; Gynecology; HIV Infections - complications; HIV Infections - immunology; Humans; India - epidemiology; Male; Medicine; Medicine & Public Health; Original Article; Patient Outcome Assessment; Pediatrics; Prevalence; Thinness - diagnosis; Thinness - epidemiology; Thinness - etiology; Time-to-Treatment
• ISSN: 0019-5456; 0973-7693
• DOI: 10.1007/s12098-014-1659-1

Objective To describe catch-up growth after antiretroviral therapy (ART) initiation among children living with human immunodeficiency virus (CLHIV), attending a private clinic in India. Methods 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. Results 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. Conclusions 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.