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Growth and pubertal development in HIV-infected adolescents

Williams, Paige, L.a; Jesson, Julieb

Current Opinion in HIV and AIDS: May 2018 - Volume 13 - Issue 3 - p 179–186
doi: 10.1097/COH.0000000000000450
ADOLESCENTS AND HIV: Edited by Mary-Ann Davies and Elizabeth Hamlyn

Purpose of review We present an overview of recent research in the inter-related areas of growth and pubertal development among adolescents with HIV. Growth deficits early in childhood can lead to delayed puberty, with subsequent effects on pubertal growth spurts and bone health.

Recent findings Impaired growth remains a critical concern, particularly in low-resource settings, where stunting, wasting and underweight remain pervasive. Antiretroviral treatment (ART) initiation results in improved growth, with greatest growth recovery in the first years and more improvement in weight than in height. However, even years after ART initiation, growth deficits persist in low-resource settings (LRS), and adolescents appear at particularly increased risk. The high prevalence of stunting translates to delays in pubertal onset and sexual maturity. In contrast, HIV-infected adolescents in developed countries do not demonstrate persistent wasting, yet still have delayed pubertal development. Impaired growth increases the risk for mortality, virologic failure, and abnormal bone health, as well as increased depression and stigma.

Summary Early initiation of ART across all age groups regardless of immunological status is essential for restoring growth. Coordination of ART initiation, nutritional supplementation programs, and concurrent prophylaxis is required to ameliorate growth deficits and pubertal delays, particularly in LRS.

aDepartment of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA

bInserm U1027, Université Toulouse 3 Paul Sabatier, Toulouse, France

Correspondence to Paige L. Williams, PhD, Department of Biostatistics, Harvard T.H. Chan School of Public Health, 655 Huntington Avenue, Boston, MA 02115, USA. Tel: +1 617 432 3872; e-mail:

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