Feucht Ute D, Van Bruwaene Lore, Becker Piet J, Kruger Mariana
Department of Paediatrics, Kalafong Hospital, University of Pretoria, Pretoria, South Africa.
University Hospital Gasthuisberg, Leuven, Belgium.
Trop Med Int Health. 2016 May;21(5):619-29. doi: 10.1111/tmi.12685. Epub 2016 Mar 21.
To describe growth in HIV-infected children on long-term antiretroviral therapy (ART) and to assess social, clinical, immunological and virological factors associated with suboptimal growth.
This observational cohort study included all HIV-infected children at an urban ART site in South Africa who were younger than 5 years at ART initiation and with more than 5 years of follow-up. Growth was assessed using weight-for-age Z-scores (WAZ), height-for-age Z-scores (HAZ) and body mass index (BMI)-for-age Z-scores (BAZ). Children were stratified according to pre-treatment anthropometry and age. Univariate and mixed linear analysis were used to determine associations between independent variables and weight and height outcomes.
The majority of the 159 children presented with advanced clinical disease (90%) and immunosuppression (89%). Before treatment underweight, stunting and wasting were common (WAZ<-2 = 50%, HAZ<-2 = 73%, BAZ<-2 = 19%). Weight and BMI improved during the initial 12 months, while height improved over the entire 5-year period. Height at study exit was significantly worse for children with growth impairment at ART initiation (P < 0.001), and infants (<1 year) demonstrated superior improvement in terms of BMI (P = 0.04). Tuberculosis was an independent risk factor for suboptimal weight (P = 0.01) and height (P = 0.02) improvement. Weight gain was also hindered by lack of electricity (P = 0.04). Immune reconstitution and virological suppression were not associated with being underweight or stunted at study endpoint.
Malnutrition was a major clinical concern for this cohort of HIV-infected children. Early ART initiation, tuberculosis co-infection management and nutritional interventions are crucial to ensure optimal growth in HIV-infected children.
描述接受长期抗逆转录病毒治疗（ART）的HIV感染儿童的生长情况，并评估与生长欠佳相关的社会、临床、免疫和病毒学因素。
这项观察性队列研究纳入了南非一个城市ART治疗点所有开始接受ART治疗时年龄小于5岁且随访超过5年的HIV感染儿童。使用年龄别体重Z评分（WAZ）、年龄别身高Z评分（HAZ）和年龄别体重指数（BMI）Z评分（BAZ）评估生长情况。根据治疗前人体测量数据和年龄对儿童进行分层。采用单变量和混合线性分析来确定自变量与体重和身高结果之间的关联。
159名儿童中大多数患有晚期临床疾病（90%）和免疫抑制（89%）。治疗前体重不足、发育迟缓及消瘦情况常见（WAZ<-2 = 50%，HAZ<-2 = 73% , BAZ<-2 = 19%）。体重和BMI在最初12个月有所改善，而身高在整个5年期间均有改善。开始ART治疗时存在生长障碍的儿童在研究结束时的身高明显更差（P < 0.001），婴儿（<1岁）在BMI方面的改善更显著（P = 0.04）。结核病是体重（P = 0.01）和身高（P = 0.02）改善欠佳的独立危险因素。缺电也阻碍了体重增加（P = 0.04）。免疫重建和病毒学抑制与研究终点时体重不足或发育迟缓无关。
营养不良是这组HIV感染儿童的主要临床问题。尽早开始ART治疗、管理结核合并感染及进行营养干预对于确保HIV感染儿童实现最佳生长至关重要。
