In girls, across each of the baseline HAZ groups (Fig. 2ai–iv), children starting ART in the oldest age group had growth spurts on average 0.41 [95% confidence interval (95% CI) 0.20–0.62] years later than those starting ART in the youngest age group. Across the baseline age groups (Fig. 2bi–iii), girls starting ART with low HAZ had later growth spurts; there was a 1.50 (1.21–1.78) year delay in those with baseline HAZ less than −3 compared with baseline HAZ at least −1. The effect of this delay on overall height can be seen in Fig. 2b iv-vi; the differences in height are smaller from age 16 onwards (after the growth spurt) than at age 8 years.
In boys, the association between baseline age and the timing of the growth spurt differed by baseline HAZ (Fig. 3ai–iv); there was no significant difference by age in boys who started ART with HAZ at least −1 (Fig. 3ai). In boys with baseline HAZ of −2 to less than −1 (Fig. 3aii), the growth spurt was 0.96 (0.19–1.72) years later in those starting ART in the oldest compared with the youngest age group. Similarly, for a baseline HAZ of −3 to less than −2 (Fig. 3aiii), the corresponding delay in those starting ART in the oldest age group was 0.92 (0.17–1.66) years, and for baseline HAZ less than −3, it was 0.42 (−0.32 to 1.16) years (Fig. 3aiv). The timing of the growth spurt in boys did not differ significantly by baseline HAZ (Fig. 3bi–iii).
Girls (Fig. 2bv) and boys (Fig. 3bv), who started treatment with a baseline HAZ at least −1, maintained a similar mean height to the WHO reference, regardless of baseline age.
3.3 Other factors associated with growth from age 8 years
Characteristics associated with variations in growth that remained after adjusting for differences in baseline HAZ and age are summarized in Table 2. Young people from Thailand were smaller throughout adolescence than those from other countries, but did not differ in the timing of the growth spurt. The shape of the growth spurt differed by country and was shorter in children from the UK and Ireland than elsewhere. Lower zBMI at ART initiation was significantly associated with a later growth spurt [a one SD decrease was associated with a 0.07 (0.02–0.11) year delay in the growth spurt]. In a second model (data not shown), a one SD decrease in zBMI at age 8 years was associated with a 0.16 (0.09–0.22) year delay in the timing of the growth spurt, while other parameters did not change substantially. There was no evidence of any interactions.
In subgroup analysis (n = 545), there was a significant interaction between sex and being born abroad on timing of the growth spurt (P = 0.038). Girls born abroad experienced a growth spurt 0.24 (0.02–0.46) years earlier than those born in the cohort country, although there was no association in boys. However, after adjusting for zBMI at age 8, the association was no longer significant [growth spurt for girls born abroad was 0.18 (−0.05 to 0.42) years earlier].
In the three sensitivity analyses wherein models were fitted separately to children from Thailand and elsewhere, Thai-specific reference data were used for Thai children and children starting ART age at least 8 years were excluded, overall conclusions were unchanged (data not shown).
In this study, we described growth throughout adolescence in a large cohort of young people with vertically acquired HIV in Europe and Thailand. Although all adolescents in the study initiated ART before age 11 years, growth deficits remained throughout adolescence. Only children with HAZ at least −1 when starting ART were able to achieve a similar height to the WHO reference at age 16 years, suggesting that for others, catch up growth associated with being on ART long term was not sufficient to restore height to what would be expected in an HIV-negative population.
We observed an association between older age at ART initiation and later growth spurts in boys (with HAZ <−1 at ART initiation) and girls, in line with findings from the Antiretroviral research for Watoto (ARROW) trial wherein attainment of each tanner stage and onset of menarche was delayed in those starting ART at older ages . We also observed an association between stunting and later growth spurts, but only in girls. The potential role of anthropometric parameters in early childhood on growth during puberty was highlighted in a study of 2539 young people with vertically acquired HIV and HIV-exposed uninfected (HEU) young people from the USA . Young people living with HIV reached sexual maturity on average 6 months later than the HEU group, but differences in HAZ prior to puberty accounted for up to 98% of the delay in boys and (together with zBMI) 74% in girls, suggesting much of the delay may be attributable to earlier poor growth . Low HAZ at ART initiation was also associated with delayed attainment of all Tanner stages in boys and girls, and menarche in girls, independently of age at ART initiation in the ARROW trial . However, in boys, the delay was reduced in those who had the greatest initial gains in CD4+ cell count after starting ART, but there was no similar association in girls. Undernutrition early in life was also found to have a stronger association with adult height in women than men in the Netherlands . Although this suggests that girls may be more sensitive to impairments early in life, and prior to ART, the mechanism underlying potential sex differences remain to be explained.
After accounting for HAZ and age at ART initiation, we found no association between WHO immunological status or viral load at ART initiation and growth. Similarly, the ARROW trial found immune suppression prior to ART was not associated with delayed puberty or menarche . Other studies have also reported a lack of association between clinical status at start of puberty and age at onset [4,7]. However, in young people in the USA, low CD4+ cell count and high viral load at first pubertal assessment were associated with later pubertal onset. Among boys, prior CDC C, low nadir CD4% or high peak viral load were also associated with later puberty . However, many of these young people initiated ART on mono or dual therapy and are likely to have substantially different treatment histories compared with our study.
We found zBMI at ART initiation and age 8 to be associated with the timing of the growth spurt, with no evidence of a difference between boys and girls. We also observed that girls born abroad experienced an earlier pubertal growth spurt than girls born in the cohort country, but the differences in the timing of the growth spurt reduced after adjusting for zBMI at age 8. In girls, a relationship between low BMI and delayed puberty has been found in multiple studies  and rapid weight gain prior to puberty also linked to early onset . Differences between young people born abroad and those born in the country may therefore be explained by periods of more rapid weight gain in children arriving from abroad, the majority from Africa, compared with those born in the country.
This study had several limitations; as with all observational studies, our findings on the association between age and HAZ at ART initiation and growth should not be over interpreted or assumed to be causative. At ART initiation, stunting was strongly correlated with immunosuppression, viral load and zBMI and may be a marker for poor immunological status and other impairments. Children starting ART at older ages represent a group who have survived without treatment and possibly with limited access to care and so may be subject to a survivor bias. Had ART initiation been delayed in those who started at a young age, the observed delay in the growth spurt associated with starting ART at an older age may have been less in this group who would also have been more likely to have access to healthcare and regular monitoring. Nonetheless, the findings provide insight in to growth patterns among children presenting to care and starting ART at different ages.
Inclusion criteria applied also lead to the potential for selection bias. We excluded children with missing height data. Multiple imputation was not possible, as other data, such as immunological and virological status, at ART initiation, likely to be strong predictors of baseline height were missing in more than half of the children with missing heights. We excluded young people from Russia, Ukraine and Italy where height data were not routinely recorded. Further, the cohorts included in EPPICC range from national coverage to city hospitals leading to potential for bias where children treated in large city hospitals are not representative of others in the country. Our analyses were restricted to children aged 1–10 years at ART initiation. The number of infants initiating ART under age 1 year was small, with high rates of missing baseline data. A further limitation is the lack of quantitative measures of pubertal status such as Tanner stage and date of onset of menarche, which is not routinely collected by the majority of participating cohorts. However, differences in timing of the growth spurt are likely to be indicative of differences in the timing of onset of puberty.
Finally, we used the WHO growth standard  and growth reference  to derive z-scores at ART initiation. Although the WHO growth standards were developed to assess growth globally, children from Thailand were significantly shorter than those residing in Europe and the WHO reference may overestimate stunting as compared to Thailand's own national growth reference . However, in sensitivity analyses, using Thai reference data, we did not find any difference in the associations between baseline HAZ and growth during adolescence.
Despite these limitations, the study has several strengths. The collaborative nature of the study provides a rich source of longitudinal height measurements from a large sample of young people living with HIV followed during childhood and adolescence and the use of SITAR models provides insight into growth during puberty in the absence of quantitative measures of pubertal status.
In summary, we have shown that children who initiate ART at younger ages are taller. Children who initiate ART with a ‘normal’ height for age z-score (HAZ ≥−1) remained with a ‘normal’ height throughout adolescence. Those who initiated ART stunted or severely stunted were less likely to achieve ‘normal’ height. We also demonstrated that in girls, regardless of age at ART initiation, stunting at time of initiation was associated with a later pubertal growth spurt, and this continued growth into later adolescents may allow those most severely stunted to catch-up somewhat. However, longer-term follow-up is required to understand the potential implications of delayed pubertal growth on outcomes in later life.
We thank all the patients for their participation in these cohorts, and the staff members who cared for them.
Author contributors: Writing Group (consisting of Project Team first (ordered alphabetically by name except for the first and last author), and also other Writing Group members (ordered alphabetically by cohort name)):
Project Team: Siobhan Crichton (EPPICC statistician), Eric Belfrage (Karolinska Institutet and University Hospital, Stockholm, Sweden), Intira Jeanne Collins (Collaborative HIV Paediatric Study (CHIPS), UK and Ireland), Katja Doerholt (Collaborative HIV Paediatric Study (CHIPS), UK and Ireland), Ali Judd (co-lead of EPPICC), Sophie Le Coeur (Thailand Program for HIV Prevention and Treatment (PHPT) Study Group, Thailand), Vana Spoulou (Greece Cohort, Greece), Ruth Goodall (EPPICC senior statistician).
Other Writing Group members: Henriette Scherpbier, Colette Smit (ATHENA paediatric cohort, Netherlands); Tessa Goetghebuer (Hospital St Pierre Cohort, Brussels, Belgium); Diana M. Gibb (Collaborative HIV Paediatric Study (CHIPS) and National Study of HIV in Pregnancy and Childhood (NSHPC), UK & Ireland); Antoni Noguera (CoRISPE-CAT, Catalonia cohort, Spain) Maria Luisa Navarro, Jose Tomas Ramos (CoRISPE-S, rest of Spain cohort, Spain); Luisa Galli (Italian Register for HIV infection in children, Italy); Carlo Giaquinto, Claire Thorne (Paediatric European Network for the Treatment of AIDS (PENTA), Italy); Santa Ansone (Latvian cohort, Latvia); Magdalena Marczynska (Polish paediatric cohort, Poland); Liubov Okhonskaia (Republican Hospital of Infectious Diseases, St Petersburg, Russia); Begoña Martinez de Tejada (Swiss Mother and Child HIV Cohort Study, Switzerland); Gonzague Jourdain, Luc Decker (Thailand Program for HIV Prevention and Treatment (PHPT) Study Group, Thailand); Luminita Ene (’Victor Babes’ Hospital Cohort, Romania).
Belgium: Hospital St Pierre Cohort, Brussels: Tessa Goetghebuer, MD, PhD; Marc Hainaut, MD PhD; Evelyne Van der Kelen, Research nurse; Marc Delforge, data manager.
Greece: Greek cohort: Vana Spoulou.
Italy: Italian Register for HIV infection in Children. Coordinators: Maurizio de Martino (Florence), Pier Angelo Tovo (Turin). Participants: Osimani Patrizia (Ancona), Domenico Larovere (Bari), Maurizio Ruggeri (Bergamo), Giacomo Faldella, Francesco Baldi (Bologna) Raffaele Badolato (Brescia), Carlotta Montagnani, Elisabetta Venturini, Catiuscia Lisi (Florence), Antonio Di Biagio, Lucia Taramasso (Genua), Vania Giacomet, Paola Erba, Susanna Esposito, Rita Lipreri, Filippo Salvini, Claudia Tagliabue (Milan), Monica Cellini (Modena), Eugenia Bruzzese, Andrea Lo Vecchio (Naples), Osvalda Rampon, Daniele Donà (Padua), Amelia Romano (Palermo), Icilio Dodi (Parma), Anna Maccabruni (Pavia), Rita Consolini (Pisa), Stefania Bernardi, Hyppolite Tchidjou Kuekou, Orazio Genovese (Rome), Paolina Olmeo (Sassari), Letizia Cristiano (Taranto), Antonio Mazza (Trento), Clara Gabiano, Silvia Garazzino (Turin), Antonio Pellegatta (Varese)
Latvia: Latvian Cohort (Santa Ansone).
Netherlands: The ATHENA database is maintained by Stichting HIV Monitoring and supported by a grant from the Dutch Ministry of Health, Welfare and Sport through the Centre for Infectious Disease Control of the National Institute for Public Health and the Environment.
CLINICAL CENTRES (PAEDIATRIC CARE)
Emma Kinderziekenhuis, Amsterdam, University Medical Centers:HIV treating physicians: D. Pajkrt, H.J. Scherpbier. HIV nurse consultants: A.M. Weijsenfeld, C.G de Boer. HIV clinical virologists/chemists: S. Jurriaans, N.K.T. Back, H.L. Zaaijer, B. Berkhout, M.T.E. Cornelissen, C.J. Schinkel, K.C.wolthers. Erasmus MC–Sophia, Rotterdam:HIV treating physicians: P.L.A. Fraaij, A.M.C. van Rossum, C.L. Vermont. HIV nurse consultants: L.C. van der Knaap, E.G. Visser. HIV clinical virologists/chemists: C.A.B. Boucher, M.P.G Koopmans, J.J.A van Kampen, S.D. Pas. Radboudumc, Nijmegen:HIV treating physicians: S.S.V. Henriet, M. van de Flier, K. van Aerde. HIV nurse consultants: R. Strik-Albers. HIV clinical virologists/chemists: J. Rahamat-Langendoen, F.F. Stelma. Universitair Medisch Centrum Groningen, Groningen:HIV treating physicians: E.H. Schölvinck. HIV nurse consultants: H. de Groot-de Jonge. HIV clinical virologists/chemists: H.G.M. Niesters, C.C. van Leer-Buter, M. Knoester. Wilhelmina Kinderziekenhuis, UMC Utrecht, Utrecht:HIV treating physicians: L.J. Bont, S.P.M. Geelen, T.F.W. Wolfs. HIV nurse consultants: N. Nauta. HIV clinical virologists/chemists: R. Schuurman, F. Verduyn-Lunel, A.M.J. Wensing.
Director: P. Reiss. Deputy director: S. Zaheri. Data analysis: D.O. Bezemer, A.I. van Sighem, C. Smit, F.W.M.N. Wit. Data management and quality control: M. Hillebregt, A. de Jong, T. Woudstra. Data monitoring: D. Bergsma, S. Grivell, R. Meijering, M. Raethke, T. Rutkens. Data collection: L. de Groot, M. van den Akker, Y. Bakker, M. Bezemer, A. El Berkaoui, J. Geerlinks, J. Koops, E. Kruijne, C. Lodewijk, E. Lucas, R. van der Meer, L. Munjishvili, F. Paling, B. Peeck, C. Ree, R. Regtop, Y. Ruijs, L. van de Sande, M. Schoorl, P. Schnörr, E. Tuijn, L. Veenenberg, S. van der Vliet, A. Wisse, E.C. Witte. Patient registration: B. Tuk.
Poland: Polish paediatric cohort: Head of the team: Prof Magdalena Marczyńska, MD, PhD Members of the team: Jolanta Popielska, MD, PhD; Maria Pokorska-Śpiewak, MD, PhD; Agnieszka Ołdakowska, MD, PhD; Konrad Zawadka, MD, PhD; Urszula Coupland, MD, PhD Administration assistant: Małgorzata Doroba. Affiliation: Medical University of Warsaw, Poland, Department of Children's Infectious Diseases; Hospital of Infectious Diseases in Warsaw, Poland.
Romania: ‘Victor Babes’ Hospital Cohort, Bucharest: Dr Luminita Ene.
Russia: Federal State-owned Institution ‘Republican Clinical Infectious Diseases Hospital’ of the Ministry of Health of the Russian Federation, St Petersburg: Liubov Okhonskaia, Evgeny Voronin, Milana Miloenko, Svetlana Labutina
Spain: CoRISPE-cat, Catalonia: financial support for CoRISPE-cat was provided by the Instituto de Salud Carlos III through the Red Temática de Investigación Cooperativa en Sida. Members: Hospital Universitari Vall d’Hebron, Barcelona (Pere Soler-Palacín, Maria Antoinette Frick and Santiago Pérez-Hoyos (statistician)), Hospital Universitari del Mar, Barcelona (Antonio Mur, Núria López), Hospital Universitari Germans Trias i Pujol, Badalona (María Méndez), Hospital Universitari JosepTrueta, Girona (Lluís Mayol), Hospital Universitari Arnau de Vilanova, Lleida (Teresa Vallmanya), Hospital Universitari Joan XXIII, Tarragona (Olga Calavia), Consorci Sanitari del Maresme, Mataró (Lourdes García), Hospital General de Granollers (Maite Coll), Corporació Sanitària Parc Taulí, Sabadell (Valentí Pineda), Hospital Universitari Sant Joan, Reus (Neus Rius), Fundació Althaia, Manresa (Núria Rovira), Hospital Son Espases, Mallorca (Joaquín Dueñas) and Hospital Sant Joan de Déu, Esplugues (Anna Gamell, Clàudia Fortuny, Antoni Noguera-Julian).
Spain: CoRISPE-S and Madrid cohort: María José Mellado, Luis Escosa, Milagros García Hortelano, Talía Sainz (Hospital La Paz);María Isabel González- Tomé, Pablo Rojo, Daniel Blázquez (Hospital Doce de Octubre, Madrid); José Tomás Ramos (Hospital Clínico San Carlos, Madrid); Luis Prieto, Sara Guillén (Hospital de Getafe); María Luisa Navarro, Jesús Saavedra, Mar Santos, Mª Angeles Muñoz, Beatriz Ruiz, Carolina Fernandez Mc Phee, Santiago Jimenez de Ory,Susana Alvarez (Hospital Gregorio Marañón); Miguel Ángel Roa (Hospital de Móstoles); José Beceiro (Hospital Príncipe de Asturias, Alcalá de Henares); Jorge Martínez (Hospital Niño Jesús, Madrid); Katie Badillo (Hospital de Torrejón); Miren Apilanez (Hospital de Donostia, San Sebastián); Itziar Pocheville (Hospital de Cruces, Bilbao); Elisa Garrote (Hospital de Basurto, Bilbao); Elena Colino (Hospital Insular Materno Infantil, Las Palmas de Gran Canaria); Jorge Gómez Sirvent (Hospital Virgen de la Candelaria, Santa Cruz de Tenerife); Mónica Garzón, Vicente Román (Hospital de Lanzarote); Abián Montesdeoca, Mercedes Mateo (Complejo Universitario de Canarias, La Laguna-Tenerife),María José Muñoz, Raquel Angulo (Hospital de Poniente, El Ejido); Olaf Neth, Lola Falcón (Hospital Virgen del Rocio, Sevilla); Pedro Terol (Hospital Virgen de la Macarena, Sevilla); Juan Luis Santos (Hospital Virgen de las Nieves, Granada); David Moreno (Hospital Carlos Haya, Málaga); Francisco Lendínez (Hospital de Torrecárdenas, Almería); Ana Grande (Complejo Hospitalario Universitario Infanta Cristina, Badajoz); Francisco José Romero (Complejo Hospitalario de Cáceres); Carlos Pérez (Hospital de Cabueñes, Gijón); Miguel Lillo (Hospital de Albacete); Begoña Losada (Hospital Virgen de la Salud, Toledo); Mercedes Herranz (Hospital Virgen del Camino, Pamplona); Matilde Bustillo, Carmelo Guerrero (Hospital Miguel Servet, Zaragoza); Pilar Collado (Hospital Clínico Lozano Blesa, Zaragoza); José Antonio Couceiro (Complejo Hospitalario de Pontevedra); Amparo Pérez, Ana Isabel Piqueras, Rafael Bretón, Inmaculada Segarra (Hospital La Fe, Valencia); César Gavilán (Hospital San Juan de Alicante); Enrique Jareño (Hospital Clínico de Valencia); Elena Montesinos (Hospital General de Valencia); Marta Dapena (Hospital de Castellón); Cristina Álvarez (Hospital Marqués de Valdecilla, Santander); Ana Gloria Andrés (Hospital de León); Víctor Marugán, Carlos Ochoa (Hospital de Zamora); Santiago Alfayate, Ana Isabel Menasalvas (Hospital Virgen de la Arrixaca, Murcia); Elisa de Miguel (Complejo Hospitalario San Millán-San Pedro, Logroño) and Paediatric HIV-BioBank integrated in the Spanish AIDS Research Network and collaborating Centers.
Funding: This work has been partially funded by the Fundación para la Investigación y Prevención de SIDA en España (FIPSE) (FIPSE 3608229/09, FIPSE 240800/09, FIPSE 361910/10), Red Temática de Investigación en SIDA (RED RIS) supported by Instituto de Salud Carlos III (ISCIII) (RD12/0017/0035 and RD12/0017/0037), project as part of the Plan R+D+I and cofinanced by ISCIII- Subdirección General de Evaluación and Fondo Europeo de Desarrollo Regional (FEDER),Mutua Madrileña 2012/0077, Gilead Fellowship 2013/0071, FIS PI15/00694,CoRISpe (RED RIS RD06/0006/0035 y RD06/0006/0021).
Sweden: Karolinska University Hospital, Stockholm (Lars Naver, Sandra Soeria-Atmadja, Vendela Hagås).
Switzerland:Members of the Swiss HIV Cohort Study (SHCS) and the Swiss Mother and Child HIV Cohort Study: Aebi-Popp K, Anagnostopoulos A, Asner S, Battegay M, Baumann M, Bernasconi E, Böni J, Braun DL, Bucher HC, Calmy A, Cavassini M, Ciuffi A, Duppenthaler A, Dollenmaier G, Egger M, Elzi L, Fehr J, Fellay J, Francini K, Furrer H, Fux CA, Grawe C, Günthard HF (President of the SHCS), Haerry D (deputy of ‘Positive Council’), Hasse B, Hirsch HH, Hoffmann M, Hösli I, Huber M, Kahlert CR (Chairman of the Mother & Child Substudy), Kaiser L, Keiser O, Klimkait T, Kottanattu L, Kouyos RD, Kovari H, Ledergerber B, Martinetti G, Martinez de Tejada B, Marzolini C, Metzner KJ, Müller N, Nicca D, Paioni P, Pantaleo G, Perreau M, Polli Ch, Rauch A (Chairman of the Scientific Board), Rudin C, Scherrer AU (Head of Data Centre), Schmid P, Speck R, Stöckle M (Chairman of the Clinical and Laboratory Committee), Tarr P, Thanh Lecompte M, Trkola A, Vernazza P, Wagner N, Wandeler G, Weber R, Wyler CA, Yerly S. Funding: This study has been financed within the framework of the Swiss HIV Cohort Study, supported by the Swiss National Science Foundation (grant #177499).
Thailand: Program for HIV Prevention & Treatment (PHPT). Participating hospitals: Lamphun: Pornpun Wannarit; Phayao Provincial Hospital: Pornchai Techakunakorn; Chiangrai Prachanukroh: Rawiwan Hansudewechakul; Chiang Kham: Vanichaya Wanchaitanawong; Phan: Sookchai Theansavettrakul; Mae Sai: Sirisak Nanta; Prapokklao: Chaiwat Ngampiyaskul; Banglamung: Siriluk Phanomcheong; Chonburi: Suchat Hongsiriwon; Rayong: Warit Karnchanamayul; Bhuddasothorn Chacheongsao: Ratchanee Kwanchaipanich; Nakornping: Suparat Kanjanavanit; Somdej Prapinklao: Nareerat Kamonpakorn, Maneeratn Nantarukchaikul; Bhumibol Adulyadej: Prapaisri Layangool, Jutarat Mekmullica; Pranangklao: Paiboon Lucksanapisitkul, Sudarat Watanayothin; Buddhachinaraj: Narong Lertpienthum; Hat Yai: Boonyarat Warachit; Regional Health Promotion Center 6, Khon Kaen: Sansanee Hanpinitsak; Nong Khai: Sathit Potchalongsin; Samutsakhon: Pimpraphai Thanasiri, Sawitree Krikajornkitti; Phaholpolphayuhasena: Pornsawan Attavinijtrakarn; Kalasin: Sakulrat Srirojana; Nakhonpathom: Suthunya Bunjongpak; Samutprakarn: Achara Puangsombat; Mahasarakam: Sathaporn Na-Rajsima; Roi-et: Pornchai Ananpatharachai; Sanpatong: Noppadon Akarathum; Vachira Phuket: Weerasak Lawtongkum; Chiangdao: Prapawan Kheunjan, Thitiporn Suriyaboon, Airada Saipanya.
Data management team: Kanchana Than-in-at, Nirattiya Jaisieng, Rapeepan Suaysod, Sanuphong Chailoet, Naritsara Naratee, and Suttipong Kawilapat.
UK & Ireland: Collaborative HIV Paediatric Study (CHIPS): CHIPS is funded by the NHS (London Specialised Commissioning Group) and has received additional support from Bristol-Myers Squibb, Boehringer Ingelheim, GlaxoSmithKline, Roche, Abbott, and Gilead Sciences. The MRC Clinical Trials Unit at UCL is supported by the Medical Research Council (https://www.mrc.ac.uk) programme number MC_UU_12023/26.
CHIPS Steering Committee: Hermione Lyall (chair), Alasdair Bamford, Karina Butler, Katja Doerholt, Conor Doherty, Caroline Foster, Kate Francis, Ian Harrison, Julia Kenny, Nigel Klein, Gillian Letting, Paddy McMaster, Fungai Murau, Edith Nsangi, Helen Peters, Katia Prime, Andrew Riordan, Fiona Shackley, Delane Shingadia, Sharon Storey, Claire Thorne, Gareth Tudor-Williams, Anna Turkova, Steve Welch. MRC Clinical Trials Unit: Intira Jeannie Collins, Claire Cook, Siobhan Crichton, Donna Dobson, Keith Fairbrother, Diana M. Gibb, Lynda Harper, Ali Judd, Marthe Le Prevost, Nadine Van Looy. National Study of HIV in Pregnancy and Childhood, UCL: Helen Peters, Claire Thorne.
Participating hospitals: Republic of Ireland: Our Lady's Children's Hospital Crumlin, Dublin: K Butler, A Walsh. UK: University Hospitals Birmingham NHS Foundation Trust, Birmingham: L Thrasyvoulou, S Welch; University Hospitals Bristol NHS Foundation Trust, Bristol: J Bernatoniene, F Manyika; Calderdale and Huddersfield NHS Foundation Trust, Halifax: G Sharpe; Derby Teaching Hospitals NHS Foundation Trust: B Subramaniam; Middlesex: K Sloper; East Sussex Healthcare NHS Trust, Eastbourne: K Fidler, Glasgow Royal Hospital for Children, Glasgow: R Hague, V Price; Great Ormond Street Hospital for Children NHS Foundation Trust, London: M Clapson, J Flynn, A Cardoso M Abou – Rayyah, N Klein, D Shingadia; Homerton University Hospital NHS Foundation Trust, London: D Gurtin, Oxford University Hospitals NHS Foundation Trust, Oxford: S Yeadon, S Segal; King's College Hospital NHS Foundation Trust, London: C Ball, S Hawkins; Leeds Teaching Hospitals NHS Trust, Leeds: M Dowie; University Hospitals of Leicester NHS Trust, Leicester: S Bandi, E Percival; Luton and Dunstable Hospital NHS Foundation Trust, Luton: M Eisenhut; K Duncan, S Clough; Milton Keynes General University Hospital NHS Foundation Trust, Milton Keynes: Dr L Anguvaa, S Conway, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle: T Flood, A Pickering; The Pennine Acute Hospitals NHS Trust, Manchester: P McMaster C Murphy; North Middlesex University Hospital NHS Trust, London: J Daniels, Y Lees; Northampton General Hospital NHS Trust, Northampton: F Thompson; London North West Healthcare NHS Trust, Middlesex; B Williams, S Pope; Nottingham University Hospitals NHS Trust, Nottingham: L Cliffe, A Smyth, S Southall; Portsmouth Hospitals NHS Trust, Portsmouth: A Freeman; Raigmore Hospital, Inverness: H Freeman; Royal Belfast Hospital for Sick Children, Belfast: S Christie; Royal Berkshire NHS Foundation Trust, Reading: A Gordon; Royal Children's Hospital, Aberdeen: D Rogahn L Clarke; Royal Edinburgh Hospital for Sick Children, Edinburgh: L Jones, B Offerman; Royal Free NHS Foundation Trust, London: M Greenberg; Alder Hey Children's NHS Foundation Trust, Liverpool: C Benson, A Riordan; Sheffield Children's NHS Foundation Trust, Sheffield: L Ibberson, F Shackley; University Hospital Southampton NHS Foundation Trust, Southampton: SN Faust, J Hancock; St George's University Hospitals NHS Foundation Trust, London: K Doerholt, K Prime, M Sharland, S Storey; Imperial College Healthcare NHS Trust, London: H Lyall, C Monrose, P Seery, G Tudor-Williams; Guy's and St Thomas’ NHS Foundation Trust, London:, E Menson, A Callaghan; University Hospitals of North Midlands NHS Trust, Stoke On Trent: A Bridgwood, P McMaster; University Hospital of Wales, Cardiff: J Evans, E Blake; NHS Frimley Health Foundation Trust, Slough: A Yannoulias.
Funding: EPPICC receives funding from the PENTA Foundation (http://penta-id.org). The MRC Clinical Trials Unit at UCL is supported by the Medical Research Council (programme number MC_UU_12023/26).
5.1 Conflicts of interest
There are no conflicts of interest.
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* Please see Acknowledgements section for list of Writing Group members.
Europe; growth; height; HIV; perinatal; puberty; Thailand
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