Growth in virologically suppressed HIV positive children on antiretroviral therapy: individual and population-level references
Keiser, Olivia × Blaser, Nello Davies, Mary-Ann Wessa, Patrick Eley, Brian Moultrie, Harry Rabie, Helena Technau, Karl Ndirangu, James Garone, Daniela Giddy, Janet Grimwood, Ashraf Gsponer, Thomas Egger, Matthias #
Williams & Wilkins
The Pediatric Infectious Disease Journal vol:34 issue:10 pages:e254-e259
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
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.