围生期感染 HIV 的青少年的生长迟缓及生长速度：男性和女性的不同演变。来自 IeDEA 全球儿科合作的多区域分析。

Stunting and growth velocity of adolescents with perinatally acquired HIV: differential evolution for males and females. A multiregional analysis from the IeDEA global paediatric collaboration.

机构信息

Inserm U1027, Université Paul Sabatier Toulouse 3, Toulouse, France.

University of Cape Town, Centre for Infectious Disease Epidemiology and Research, Cape Town, South Africa.

出版信息

J Int AIDS Soc. 2019 Nov;22(11):e25412. doi: 10.1002/jia2.25412.

DOI:10.1002/jia2.25412

PMID:31702088

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6839428/

Abstract

INTRODUCTION

Stunting is a key issue for adolescents with perinatally acquired HIV (APH) that needs to be better understood. As part of the IeDEA multiregional consortium, we described growth evolution during adolescence for APH on antiretroviral therapy (ART).

METHODS

We included data from sub-Saharan Africa, the Asia-Pacific, and the Caribbean, Central and South America regions collected between 2003 and 2016. Adolescents on ART, reporting perinatally acquired infection or entering HIV care before 10 years of age, with at least one height measurement between 10 and 16 years of age, and followed in care until at least 14 years of age were included. Characteristics at ART initiation and at 10 years of age were compared by sex. Correlates of growth defined by height-for-age z-scores (HAZ) between ages 10 and 19 years were studied separately for males and females, using linear mixed models.

RESULTS

Overall, 8737 APH were included, with 46% from Southern Africa. Median age at ART initiation was 8.1 years (interquartile range (IQR) 6.1 to 9.6), 50% were females, and 41% were stunted (HAZ<-2 SD) at ART initiation. Males and females did not differ by age and stunting at ART initiation, CD4 count over time or retention in care. At 10 years of age, 34% of males were stunted versus 39% of females (p < 0.001). Females had better subsequent growth, resulting in a higher prevalence of stunting for males compared to females by age 15 (48% vs. 25%) and 18 years (31% vs. 15%). In linear mixed models, older age at ART initiation and low CD4 count were associated with poor growth over time (p < 0.001). Those stunted at 10 years of age or at ART initiation had the greatest growth improvement during adolescence.

CONCLUSIONS

Prevalence of stunting is high among APH worldwide. Substantial sex-based differences in growth evolution during adolescence were observed in this global cohort, which were not explained by differences in age of access to HIV care, degree of immunosuppression or region. Other factors influencing growth differences in APH, such as differences in pubertal development, should be better documented, to guide further research and inform interventions to optimize growth and health outcomes among APH.

摘要

简介

发育迟缓是接受过围生期获得性 HIV（APH）治疗的青少年的一个关键问题，需要更好地理解。作为 IeDEA 多区域联盟的一部分，我们描述了在接受抗逆转录病毒治疗（ART）期间 APH 的青春期生长演变。

方法

我们纳入了 2003 年至 2016 年期间在撒哈拉以南非洲、亚太地区和加勒比、中美洲和南美洲地区收集的数据。纳入标准为：正在接受 ART 治疗，报告围生期感染或在 10 岁前进入 HIV 护理，在 10 至 16 岁之间至少有一次身高测量，且至少在 14 岁时仍在接受护理。比较了不同性别在开始接受 ART 治疗和 10 岁时的特征。使用线性混合模型分别对 10 至 19 岁时身高与年龄比值（HAZ）定义的生长相关因素进行了研究。

结果

共有 8737 名 APH 被纳入研究，其中 46%来自南非。ART 开始治疗时的中位年龄为 8.1 岁（四分位间距 6.1 至 9.6），50%为女性，41%在开始 ART 时发育迟缓（HAZ<-2SD）。男性和女性在开始接受 ART 治疗时的年龄和发育迟缓、随着时间推移的 CD4 计数或在护理中的保留情况没有差异。10 岁时，34%的男性发育迟缓，而 39%的女性发育迟缓（p<0.001）。女性随后的生长情况较好，因此到 15 岁时，男性发育迟缓的比例（48%）高于女性（25%），到 18 岁时，男性（31%）高于女性（15%）。线性混合模型显示，ART 开始治疗时年龄较大和 CD4 计数较低与随着时间推移的生长不良相关（p<0.001）。在 10 岁或开始接受 ART 治疗时发育迟缓的患者在青春期期间生长改善最大。