Department of Epidemiology, University of Washington, Seattle, Washington, USA.
AIDS. 2011 Jan 28;25(3):345-55. doi: 10.1097/QAD.0b013e32834171db.
Patterns of growth following highly active antiretroviral therapy (HAART) administration among children are not well defined. The objective of this study was to determine rates and predictors of growth reconstitution among children on HAART.
A study was conducted among HIV-1-infected children initiating HAART at an HIV treatment clinic in Kenya. Kaplan-Meier survival curves and Cox proportional hazards regression models compared catch-up growth (Z-score ≥ 0) at 12 months post-HAART. Multivariate linear mixed-effects models determined rates and predictors of growth following HAART.
One hundred and seventy-three HIV-1-infected children initiated HAART with a median age of 4.7 years [interquartile range (IQR) 2.4, 7.0]. At baseline, children below 3 years had lower weight-for-age (WAZ) and weight-for-height (WHZ) Z-scores than children 3-5 and 6-10 years (WAZ: P = 0.03; WHZ: P = 0.006). Adjusting for baseline growth, children below 3 years were two to three-fold more likely to attain population age-norms (Z-score = 0) than 6-10 years (WAZ: P = 0.055; WHZ: P = 0.005) at 12 months post-HAART. After adjustment, children below 3 years had higher increases in WAZ and WHZ following HAART than 6-10 years (WAZ: P = 0.006; WHZ: P = 0.005). Children at WHO stage at least 3 at baseline experienced more rapid WHZ reconstitution (P = 0.002). Food supplementation while on HAART was associated with increased monthly gains in weight indices (WAZ: P = 0.001; WHZ: P = 0.005), and multivitamins were associated with greater increases in height (P < 0.01).
Following HAART initiation, younger children had more rapid catch-up to the population-average weight of their peers than older children, demonstrating growth benefit of earlier HAART. In addition to HAART, food supplementation and multivitamins may also accelerate growth reconstitution.
高效抗逆转录病毒疗法（HAART）治疗后儿童的生长模式尚未明确。本研究旨在确定接受 HAART 治疗的儿童生长恢复的速度和预测因素。
在肯尼亚的一家艾滋病毒治疗诊所，对开始接受 HAART 的 HIV-1 感染儿童进行了一项研究。采用 Kaplan-Meier 生存曲线和 Cox 比例风险回归模型比较了 HAART 后 12 个月时的追赶生长（Z 分数≥0）。采用多元线性混合效应模型确定 HAART 后生长的速度和预测因素。
173 名 HIV-1 感染儿童开始接受 HAART，中位年龄为 4.7 岁[四分位距（IQR）2.4，7.0]。基线时，3 岁以下儿童的体重与年龄比（WAZ）和体重与身高比（WHZ）Z 分数低于 3-5 岁和 6-10 岁儿童（WAZ：P=0.03；WHZ：P=0.006）。调整基线生长后，3 岁以下儿童达到人群年龄标准（Z 分数=0）的可能性是 6-10 岁儿童的两到三倍（WAZ：P=0.055；WHZ：P=0.005）在 HAART 后 12 个月。调整后，3 岁以下儿童在 HAART 后 WAZ 和 WHZ 的增长高于 6-10 岁儿童（WAZ：P=0.006；WHZ：P=0.005）。基线时至少处于世卫组织 3 期的儿童 WHZ 恢复速度更快（P=0.002）。HAART 期间进行的食物补充与体重指数（WAZ：P=0.001；WHZ：P=0.005）的每月增长增加有关，而多维元素与身高的增加有关（P＜0.01）。
HAART 开始后，较年幼的儿童比年长的儿童更快地赶上同龄人平均体重，表明早期 HAART 具有促进生长的益处。除了 HAART，食物补充和多维元素也可能加速生长恢复。
