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.
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: firstname.lastname@example.org.
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