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Pediatric Infectious Disease Journal:
doi: 10.1097/INF.0b013e3181d1e989
Original Studies

The Influence of Nutritional Status on the Response to HAART in HIV-Infected Children in South Africa

Naidoo, Reené MB ChB*; Rennert, Wolfgang MD, DMSc, DTM&H*; Lung, Audrey MD*; Naidoo, Kimesh MB ChB, FCP†; McKerrow, Neil MB ChB, FCP‡

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Abstract

Background: While the impact of HAART on growth in children is well established, the influence of prior nutritional status on the response to HAART is not well known.

Methods: A retrospective study was conducted on 120 children in South Africa. Patients were divided into 3 groups (normal, moderately underweight, and severely underweight) based on weight-for-age z-scores (WAZ). Age, weight, height, CD4 cell percentage, and viral load were recorded at initiation of HAART and after 24 months of therapy. Data were analyzed using t-tests, χ2 tests, and one-way ANOVA.

Results: At baseline, 58% of children were normal weight, 18% moderately underweight, and 23% severely underweight. After 24 months of HAART, WAZ improved significantly in moderately and severely underweight patient groups compared with the normal group. Height-for-age z-scores (HAZ) increased in all 3 groups with severely underweight children gaining more height than normal weight counterparts. Weight-for-height z-scores (WHZ) normalized in the severely underweight group. Mean CD4 cell percentages increased significantly in all 3 groups while viral loads decreased significantly in all groups with no differences among the groups at the end of 24 months of therapy. Of the entire cohort, 75% achieved undetectable HIV RNA viral loads.

Conclusions: Underlying malnutrition does not adversely affect growth, immunologic or virologic response to HAART in HIV-infected children. Underweight children exhibit an equally robust response to treatment as their well-nourished peers.

© 2010 Lippincott Williams & Wilkins, Inc.

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