Department of Pediatrics, Georgetown University Hospital, Washington, DC 20007, USA.
Pediatr Infect Dis J. 2010 Jun;29(6):511-3. doi: 10.1097/INF.0b013e3181d1e989.
While the impact of HAART on growth in children is well established, the influence of prior nutritional status on the response to HAART is not well known.
A retrospective study was conducted on 120 children in South Africa. Patients were divided into 3 groups (normal, moderately underweight, and severely underweight) based on weight-for-age z-scores (WAZ). Age, weight, height, CD4 cell percentage, and viral load were recorded at initiation of HAART and after 24 months of therapy. Data were analyzed using t-tests, chi tests, and one-way ANOVA.
At baseline, 58% of children were normal weight, 18% moderately underweight, and 23% severely underweight. After 24 months of HAART, WAZ improved significantly in moderately and severely underweight patient groups compared with the normal group. Height-for-age z-scores (HAZ) increased in all 3 groups with severely underweight children gaining more height than normal weight counterparts. Weight-for-height z-scores (WHZ) normalized in the severely underweight group. Mean CD4 cell percentages increased significantly in all 3 groups while viral loads decreased significantly in all groups with no differences among the groups at the end of 24 months of therapy. Of the entire cohort, 75% achieved undetectable HIV RNA viral loads.
Underlying malnutrition does not adversely affect growth, immunologic or virologic response to HAART in HIV-infected children. Underweight children exhibit an equally robust response to treatment as their well-nourished peers.
尽管高效抗逆转录病毒治疗（HAART）对儿童生长的影响已得到充分证实，但先前的营养状况对 HAART 反应的影响尚不清楚。
对南非的 120 名儿童进行了一项回顾性研究。根据体重与年龄的 Z 评分（WAZ），患者被分为 3 组（正常、中度消瘦和重度消瘦）。在开始 HAART 时和治疗 24 个月后，记录年龄、体重、身高、CD4 细胞百分比和病毒载量。使用 t 检验、卡方检验和单因素方差分析进行数据分析。
基线时，58%的儿童体重正常，18%的儿童中度消瘦，23%的儿童重度消瘦。在接受 24 个月的 HAART 治疗后，中度和重度消瘦组的 WAZ 与正常组相比显著改善。在所有 3 组中，身高与年龄的 Z 评分（HAZ）均增加，重度消瘦儿童比体重正常的儿童增加更多身高。体重与身高的 Z 评分（WHZ）在重度消瘦组恢复正常。所有 3 组的平均 CD4 细胞百分比均显著增加，所有组的病毒载量均显著下降，治疗 24 个月结束时各组之间无差异。在整个队列中，75%的人达到了不可检测的 HIV RNA 病毒载量。
在感染 HIV 的儿童中，基础营养不良不会对 HAART 的生长、免疫或病毒学反应产生不利影响。消瘦儿童的治疗反应与营养良好的同龄人一样强劲。
