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Growth in Virologically Suppressed HIV-Positive Children on Antiretroviral Therapy: Individual and Population-level References

Keiser, Olivia PhD*; Blaser, Nello PhD*; Davies, Mary-Ann PhD; Wessa, Patrick PhD; Eley, Brian MD§; Moultrie, Harry MD; Rabie, Helena MD; Technau, Karl-Günther MSc**; Ndirangu, James MD††; Garone, Daniela MD‡‡; Giddy, Janet MD§§; Grimwood, Ashraf MB ChB, MPH¶¶; Gsponer, Thomas PhD*; Egger, Matthias MD*†for IeDEA Southern Africa

The Pediatric Infectious Disease Journal: October 2015 - Volume 34 - Issue 10 - p e254–e259
doi: 10.1097/INF.0000000000000801
HIV Reports
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Background: Combination antiretroviral therapy (ART) suppresses viral replication in HIV-infected children. The growth of virologically suppressed children on ART has not been well documented. We aimed to develop dynamic reference curves for weight-for-age Z scores (WAZ) and height-for-age Z scores (HAZ).

Methods: Children aged <11 years at ART initiation with continuously undetectable viral loads (<400 copies/mL) treated at 7 South African ART programs with routine viral load monitoring were included. We used multilevel models to define trajectories of WAZ and HAZ up to 3 years and developed a web application to monitor trajectories in individual children.

Results: A total of 4876 children were followed for 7407 person-years. Analyses were stratified by baseline Z scores and age, which were the most important predictors of growth response. The youngest children showed the most pronounced increase in weight and height initially but catch-up growth stagnated after 1–2 years. Three years after starting ART, WAZ ranged from −2.2 [95% prediction interval (PrI), −5.6 to 0.8] in children with baseline age >5 years and Z score less than −3 to 0.0 (95% PrI, −2.7 to 2.4) in children with baseline age <2 years and WAZ greater than −1. For HAZ, the corresponding range was −2.3 (95% PrI, −4.9 to 0.3) in children with baseline age >5 years and Z score less than −3 to 0.3 (95% PrI, −3.1 to 3.4) in children with baseline age 2–5 years and HAZ greater than −1.

Conclusions: We have developed an online tool to calculate reference trajectories in fully suppressed children. The web application could help to define “optimal” growth response and identify children with treatment failure.

Supplemental Digital Content is available in the text.

From the *Institute of Social and Preventive Medicine (ISPM), University of Bern, Switzerland; School of Public Health and Family Medicine, University of Cape Town, South Africa; Leuven Institute for Research on Information Systems, KU Leuven, Belgium; §Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital, University of Cape Town, Cape Town, South Africa; Wits Reproductive Health and HIV Institute (Harriet Shezi Children’s Clinic, Chris Hani Baragwanath Hospital, Soweto), University of Witwatersrand, Johannesburg, South Africa; Tygerberg Academic Hospital, University of Stellenbosch, Stellenbosch, South Africa; **Empilweni Services and Research Unit (Rahima Moosa Mother and Child Hospital, Johannesburg) and University of Witwatersrand, Johannesburg, South Africa; ††Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Somkhele, South Africa; ‡‡Médecins Sans Frontières (MSF) South Africa, Khayelitsha, Cape Town, South Africa; §§Sinikithemba Clinic, McCord Hospital, Johannesburg, South Africa; and ¶¶Kheth’Impilo, Cape Town, South Africa.

Accepted for publication January 21, 2015.

O.K. and N.B. contributed equally.

This work was supported by the National Institute of Allergy and Infectious Diseases (5U01-AI069924–05) and the Swiss National Science Foundation (Prosper grant 32333B_131629 to O.K. and ProDoc PhD grant PDFMP3_137106 to N.B. and O.K.). The content is solely the responsibility of the authors and does not necessarily represent the official views of the funding agencies. The authors have no conflicts of interest to disclose.

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).

Address for correspondence: Olivia Keiser, PhD, Institute of Social & Preventive Medicine University of Bern, CH-3012 Bern, Switzerland. E-mail: olivia.keiser@ispm.unibe.ch.

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