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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Variability of growth in children starting antiretroviral treatment in Southern Africa
Pediatrics, Volume 130, No. 4, Year 2012
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Description
BACKGROUND: Poor growth is an indication for antiretroviral therapy (ART) and a criterion for treatment failure. We examined variability in growth response to ART in 12 programs in Malawi, Zambia, Zimbabwe, Mozambique, and South Africa. METHODS: Treatment naïve children aged <10 years were included. We calculated weight for age z scores (WAZs), height for age z scores (HAZs), and weight for height z scores (WHZs) up to 3 years after starting ART, by using the World Health Organization standards. Multilevel regression models were used. RESULTS: A total of 17 990 children (range, 238-8975) were followed for 36 181 person-years. At ART initiation, most children were underweight (50%) and stunted (66%). Lower baseline WAZ, HAZ, and WHZ were the most important determinants of faster catch-up growth on ART. WAZ and WHZ increased rapidly in the first year and stagnated or reversed thereafter, whereas HAZ increased continuously over time. Three years after starting ART, WAZ ranged from-2.80 (95% confidence interval [CI]:-3.66 to-2.02) to-1.98 (95% CI:-2.41 to 2 1.48) in children with a baseline z score <-3 and from-0.79 (95% CI:-1.62 to 0.02) to 0.05 (95% CI:-0.42 to 0.51) in children with a baseline WAZ ≥-1. For HAZ, the corresponding range was-2.33 (95% CI:-2.62 to-2.02) to-1.27 (95% CI:-1.58 to-1.00) for baseline HAZ <-3 and 20.24 (95% CI:-0.56 to 0.15) to 0.84 (95% CI: 0.53 to 1.16) for HAZ ≥ 21. CONCLUSIONS: Despite a sustained growth response and catch-up growth in children with advanced HIV disease treated with ART, normal weights and heights are not achieved over 3 years of ART. Copyright © 2012 by the American Academy of Pediatrics.
Authors & Co-Authors
Gsponer, Thomas
Switzerland, Bern
University of Bern
Weigel, Ralf
Malawi, Lilongwe
Kamuzu Central Hospital
United Kingdom, Liverpool
Liverpool School of Tropical Medicine
Davies, M. A.
South Africa, Cape Town
University of Cape Town
Bolton Moore, Carolyn
Zambia, Lusaka
Centre for Infectious Disease Research in Zambia
United States, Birmingham
The University of Alabama at Birmingham
Moultrie, Harry
South Africa, Johannesburg
Chris Hani Baragwanath Hospital
South Africa, Johannesburg
University of the Witwatersrand
Vaz, Paula
Mozambique, Maputo
Paediatric day Hospital
Rabie, Helena
South Africa, Tygerberg
Tygerberg Hospital
Technau, Karl
South Africa, Johannesburg
University of the Witwatersrand
South Africa, Johannesburg
Rahima Moosa Mother and Child Hospital
Ndirangu, James
South Africa, Durban
University of Kwazulu-natal
Eley, Brian S.
South Africa, Cape Town
University of Cape Town
Garone, Daniela Belen
Switzerland, Geneva
Medecins Sans Frontieres
Wellington, Maureen
Zimbabwe, Harare
Newlands Clinic
Giddy, Janet
South Africa, Durban
Mccord Hospital
Ehmer, Jochen
Zimbabwe
Solidarmed Art Programme
Egger, Matthias
Switzerland, Bern
University of Bern
Keiser, Olivia
Switzerland, Bern
University of Bern
Statistics
Citations: 47
Authors: 16
Affiliations: 16
Identifiers
Doi:
10.1542/peds.2011-3020
ISSN:
00314005
e-ISSN:
10984275
Research Areas
Infectious Diseases
Maternal And Child Health
Study Locations
Malawi
Mozambique
South Africa
Zambia
Zimbabwe