To evaluate immunologic response to antiretroviral treatment (ART) among HIV-infected Nigerian children (<36 months old) and to assess its association with early infant feeding pattern and nutritional status at treatment initiation.
Mixed prospective and retrospective cohort study.
One hundred fifty HIV-infected children were followed for 12 months from initiation of ART. CD4 count/CD4% was assessed at baseline and every 4–6 months. Nutritional status was assessed by height-for-age, weight-for-age and weight-for-height Z scores using the 2006 World Health Organization growth reference. Children were classified into 4 feeding groups—exclusively breast-fed, predominantly breast-fed, mixed fed and exclusively formula fed. Logistic regression was used to model odds of failure to reach CD4% of ≥25% at the 12-month follow-up. Linear random effects models were used to model the longitudinal change in CD4%.
There was a significant increase in CD4% for all children from 13.8% at baseline to 28.5% after 12 months (ΔCD4% = 14.7%, 95% confidence interval: 12.1%–17.4%). There was no association of feeding pattern with immunologic outcomes. In adjusted analyses, children who were underweight (weight-for-age < –2.0) or with CD4% <15% at baseline were 4.30 (95% confidence interval: 1.16, 15.87; P < 0.05) times and 3.41 (95% confidence interval: 1.10, 10.52; P < 0.05) times, respectively, more likely not to attain CD4% of ≥25% at 12 months.
Baseline nutritional status and CD4% were independently associated with failure to reach CD4% ≥25% at 12 months among HIV-infected Nigerian children on ART. These results emphasize the importance of early screening and initiation of ART among children in resource-poor settings before malnutrition and severe immunosuppression sets in.
Supplemental Digital Content is available in the text.
From the *Department of International Health, Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; †University of Benin Teaching Hospital, Benin City, Nigeria; ‡University of Abuja Teaching Hospital, Abuja, Nigeria; and §Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD.
Supported by IHV-UM NIH Fogarty AIDS International Training Research Program (AITRP, D43 TW001041). The authors have no other funding or conflicts of interest to disclose.
Address for correspondence: Man E. Charurat, PhD, Institute of Human Virology, University of Maryland, Baltimore, MD. E-mail: email@example.com.
Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (www.pidj.com).