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Immunologic Outcomes of Antiretroviral Therapy Among HIV-infected Nigerian Children and Its Association With Early Infant Feeding and Nutritional Status at Treatment Initiation

Omoni, Adetayo O. PhD*; Christian, Parul S. DrPH*; Sadoh, Wilson E. MB BS; Okechukwu, Adaora MB BS; Olateju, Eyinade MB BS; Omoigberale, Austin MB BS; Blattner, William MD§; Charurat, Man E. PhD§

Pediatric Infectious Disease Journal:
doi: 10.1097/INF.0b013e31828b2a2f
HIV Reports
Abstract

Objectives: 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.

Design: Mixed prospective and retrospective cohort study.

Methods: 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%.

Results: 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.

Conclusion: 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.

Author Information

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: mcharurat@ihv.umaryland.edu.

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© 2013 by Lippincott Williams & Wilkins, Inc.