Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand.
AIDS Patient Care STDS. 2009 Dec;23(12):1067-71. doi: 10.1089/apc.2009.0093.
Growth failure is a common problem in HIV-infected children. The extent to which this growth failure could be reversed after the children receive antiretroviral therapy (ART) is not known. This study assessed the incidence of growth failure in HIV-infected Thai children, impact of ART on growth, and the predictors of growth reversal after initiating ART. Growth parameters and other characteristics were extracted from the database of a prospective cohort of HIV-infected children (age <or=15 years) who were enrolled to initiate non-nucleoside reverse transcriptase inhibitor-based ART between August 2002 and May 2007. Body weight and height measurements, CD4 cell counts, plasma HIV RNA levels were collected at baseline and 24-week intervals. A total of 225 HIV-infected children were included, 116 (51%) were males. The median age at baseline was 7.4 years (interquartile range [IQR] 5.2-9.8). Fifty-three percent were in Centers for Disease Control and Prevention (CDC) category C and 54% had CD4 percentage 5 or less. The mean (standard deviation [SD]) of baseline weight-for-age (WAZ) and height-for-age (HAZ) z-scores were -2.02 (1.17) and -2.22 (1.51). The median follow-up time was 216 weeks (IQR 120-240). The cumulative probability of growth reversal among the 179 subjects with growth failure at entry was 58% (95% confidence interval [CI] 49-67) at week 240. In a multivariate Cox regression model, higher entry WAZ (p < 0.001) and HAZ (p < 0.001), use of a nevirapine-based regimen (compared to efavirenz, p = 0.027) and larger CD4% gains to week 48 (p < 0.001) were significant predictors of growth reversal after initiating ART. NNRTI-based ART leads to a substantial improvement in growth of HIV-infected children. Initiation of ART before the children developed growth failure should be encouraged.
生长发育迟缓是 HIV 感染儿童的常见问题。接受抗逆转录病毒治疗（ART）后，这种生长发育迟缓能否得到逆转尚不清楚。本研究评估了泰国 HIV 感染儿童的生长发育迟缓发生率、ART 对生长的影响，以及启动 ART 后生长逆转的预测因素。从 2002 年 8 月至 2007 年 5 月期间，前瞻性队列研究入组了年龄小于或等于 15 岁的 HIV 感染儿童，该研究的数据库中提取了生长参数和其他特征。在基线和 24 周间隔收集了体重和身高测量值、CD4 细胞计数和血浆 HIV RNA 水平。共纳入 225 名 HIV 感染儿童，其中 116 名（51%）为男性。基线时的中位年龄为 7.4 岁（四分位间距 [IQR] 5.2-9.8）。53%处于疾病控制与预防中心（CDC）C 类，54%的 CD4 百分比为 5 或更低。基线时体重与年龄（WAZ）和身高与年龄（HAZ）z 评分的平均值（标准差 [SD]）分别为-2.02（1.17）和-2.22（1.51）。中位随访时间为 216 周（IQR 120-240）。179 名入组时生长发育迟缓的患者中，有 58%（95%置信区间 [CI] 49-67）在 240 周时出现生长逆转。在多变量 Cox 回归模型中，较高的基线 WAZ（p < 0.001）和 HAZ（p < 0.001）、使用奈韦拉平为基础的方案（与依非韦伦相比，p = 0.027）以及到第 48 周时更大的 CD4%增加（p < 0.001）是启动 ART 后生长逆转的显著预测因素。基于 NNRTI 的 ART 可显著改善 HIV 感染儿童的生长发育。应鼓励在儿童出现生长发育迟缓之前启动 ART。
