Younger age at HAART initiation is associated with more rapid growth reconstitution

McGrath, Christine Ja; Chung, Michael Ha,b,d; Richardson, Barbra Ac,e; Benki-Nugent, Sarahb; Warui, Dansonf; John-Stewart, Grace Ca,b,d

doi: 10.1097/QAD.0b013e32834171db
Epidemiology and Social

Objectives: Patterns of growth following highly active antiretroviral therapy (HAART) administration among children are not well defined. The objective of this study was to determine rates and predictors of growth reconstitution among children on HAART.

Methods: A study was conducted among HIV-1-infected children initiating HAART at an HIV treatment clinic in Kenya. Kaplan–Meier survival curves and Cox proportional hazards regression models compared catch-up growth (Z-score ≥0) at 12 months post-HAART. Multivariate linear mixed-effects models determined rates and predictors of growth following HAART.

Results: One hundred and seventy-three HIV-1-infected children initiated HAART with a median age of 4.7 years [interquartile range (IQR) 2.4, 7.0]. At baseline, children below 3 years had lower weight-for-age (WAZ) and weight-for-height (WHZ) Z-scores than children 3–5 and 6–10 years (WAZ: P = 0.03; WHZ: P = 0.006). Adjusting for baseline growth, children below 3 years were two to three-fold more likely to attain population age-norms (Z-score = 0) than 6–10 years (WAZ: P = 0.055; WHZ: P = 0.005) at 12 months post-HAART. After adjustment, children below 3 years had higher increases in WAZ and WHZ following HAART than 6–10 years (WAZ: P = 0.006; WHZ: P = 0.005). Children at WHO stage at least 3 at baseline experienced more rapid WHZ reconstitution (P = 0.002). Food supplementation while on HAART was associated with increased monthly gains in weight indices (WAZ: P = 0.001; WHZ: P = 0.005), and multivitamins were associated with greater increases in height (P < 0.01).

Conclusion: Following HAART initiation, younger children had more rapid catch-up to the population-average weight of their peers than older children, demonstrating growth benefit of earlier HAART. In addition to HAART, food supplementation and multivitamins may also accelerate growth reconstitution.

Author Information

aDepartment of Epidemiology, USA

bDepartment of Medicine, USA

cDepartment of Biostatistics, USA

dDepartment of Global Health, University of Washington, USA

eDivision of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA

fCoptic Hospital, Nairobi, Kenya.

Received 19 July, 2010

Revised 30 September, 2010

Accepted 8 October, 2010

Correspondence to Christine J. McGrath, HMC, Box 359909, 325 Ninth Avenue, Seattle, WA 98104, USA. Tel: +1 206 543 4278; fax: +1 206 543 4818; e-mail:

© 2011 Lippincott Williams & Wilkins, Inc.