Effect of baseline immunological condition, virological response and duration of HAART on growth in HIV-infected adolescents
Presented by Erica Maxine Lazarus (South Africa).
E.M. Lazarus1, K. Otwombe1, L. Mohapi1, A. Cescon2,3, A. Violari1, F. Laher1
1Perinatal HIV Research Unit, Soweto, South Africa, 2Simon Fraser University, Faculty of Health Sciences, Burnaby, Canada, 3British Columbia Centre for Excellence in HIV / AIDS, Vancouver, Canada
Background: HIV infection is known to impact negatively on children's growth. Limited data exists on long-term growth outcomes of HIV-infected adolescents receiving HAART in sub-Saharan Africa. We aim to determine the correlation of baseline CD4, virological response and treatment duration with improved growth.
Methods: A retrospective cross-sectional analysis was conducted at the Perinatal HIV Research Unit in Soweto, South Africa, and included HAART-recipients aged 11-19 years at time of review. Growth was defined as the difference between gender adjusted weight-for-age and height-for-age z-score between most recent visit and baseline. We categorized baseline CD4 count as above and below 200cells/ml, and most recent VL as above and below 400 cp/ml. Chi-square contingency table analysis was performed to determine the existence of an association between growth and duration of treatment, baseline CD4, age at baseline and most recent viral load. Where an association existed, a univariate analysis was performed to determine the predictor of growth. The analysis was done at a 5% significance level.
Results: We identified 107 adolescents (53% female). Median age at HAART initiation and at time of review were 8.4 [IQR:6.07,11.4] years and 14.75 [IQR:13.49,16.47] years respectively. Median duration of HAART use was 6.1 years [IQR:2.4, 9.1]. Fifty-nine percent of adolescents had initiated HAART with CD4 count >200cells/ml, median baseline CD4 = 246cells/ml [IQR:107, 475]. At most recent visit, 84% had viral loads < 400cp/ml. Of the four parameters (treatment duration, baseline age and CD4, and most recent viral load), only baseline CD4 count showed significant association with growth in height. Children with baseline CD4 >200cells/ml had 2.7x greater odds of having improved height compared to those with baseline CD4 < 200cells/ml (p=0.019, CI:1.18, 6.2).
Conclusions: To optimize growth outcomes into adolescence, we recommend HAART initiation at baseline CD4 count >200 cells/ml for children >5 years old.
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