Growth response to antiretroviral treatment in HIV-infected children: a cohort study from Lilongwe, Malawi

Weigel, Ralf; Phiri, Sam; Chiputula, Fred; Gumulira, Joe; Brinkhof, Martin; Gsponer, Thomas; Tweya, Hannock; Egger, Matthias; Keiser, Olivia (2010). Growth response to antiretroviral treatment in HIV-infected children: a cohort study from Lilongwe, Malawi. Tropical medicine and international health TM&IH, 15(8), pp. 934-944. Oxford: Blackwell Science 10.1111/j.1365-3156.2010.02561.x

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Objective  Malnutrition is common in HIV-infected children in Africa and an indication for antiretroviral treatment (ART). We examined anthropometric status and response to ART in children treated at a large public-sector clinic in Malawi.

Methods  All children aged <15 years who started ART between January 2001 and December 2006 were included and followed until March 2008. Weight and height were measured at regular intervals from 1 year before to 2 years after the start of ART. Sex- and age-standardized z-scores were calculated for weight-for-age (WAZ) and height-for-age (HAZ). Predictors of growth were identified in multivariable mixed-effect models.

Results  A total of 497 children started ART and were followed for 972 person-years. Median age (interquartile range; IQR) was 8 years (4–11 years). Most children were underweight (52% of children), stunted (69%), in advanced clinical stages (94% in WHO stages 3 or 4) and had severe immunodeficiency (77%). After starting ART, median (IQR) WAZ and HAZ increased from −2.1 (−2.7 to −1.3) and −2.6 (−3.6 to −1.8) to −1.4 (−2.1 to −0.8) and −1.8 (−2.4 to −1.1) at 24 months, respectively (P < 0.001). In multivariable models, baseline WAZ and HAZ scores were the most important determinants of growth trajectories on ART.

Conclusions  Despite a sustained growth response to ART among children remaining on therapy, normal values were not reached. Interventions leading to earlier HIV diagnosis and initiation of treatment could improve growth response.

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