The effect of protease inhibitor therapy on growth and body composition in human immunodeficiency virus type 1-infected children.
OBJECTIVE
To determine the effect of protease inhibitors (PIs) on growth and body composition in children with human immunodeficiency virus type 1 (HIV-1) infection.


BACKGROUND
HIV-1-infected children have chronic problems with both linear growth and weight gain. Viral load may directly influence growth and nutritional status of HIV-1-infected children with reduction of viral load improving the nutritional condition.


METHODS
Data from 67 patients who initiated PI therapy between 1996 and 1999 and who were enrolled in a prospective, longitudinal study of growth and nutrition in HIV-1-infected children were analyzed. Outcomes included pre-PI versus post-PI measures of height, weight, weight-for-height, triceps skinfold thickness, and arm muscle circumference. Predictor covariates included age, race, gender, Tanner stage, CD4 z score, Centers for Disease Control and Prevention stage, route of infection, plasma HIV-1 RNA, other antiretroviral therapy, recommended daily allowances for calories, treatment with megestrol acetate, and PI therapy.


RESULTS
Sixty-seven children were followed for a median of 2.4 years with a total of 362 visits (median: 5 visits; range: 1-12). During follow-up, they received PIs for a median of 5 months. Fifty-one percent were girls, 54% black, 15% Hispanic, and 25% white. The mean age at first visit was 6.8 years. In a univariate analysis, weight z score (-0.67 to -0.35) and weight/height z score (0.25-0.76) improved on PI therapy. Using repeated-measures regression analysis, controlling for the above named covariates, PI treatment showed a significant effect on weight z score (increase in z score by 0.46), weight/height z score (increase in z score by 0.49), and arm muscle circumference (increase in percentile by 11.5). A borderline effect was found for height z score (increase in z score by 0.17) and no effect was found for triceps skinfold thickness. In a separate analysis, PI therapy increased CD4 counts twofold and reduced plasma HIV-1 RNA copies by 79%.


CONCLUSIONS
In addition to a significant reduction in viral load, PI therapy in children has a positive effect on several growth parameters, including weight, weight/height, and muscle mass.
Miller
T L
TL
Divisions, University of Rochester Medical Center, Rochester, New York 14642, USA. tracie_miller@urmc.rochester.edu
Mawn
B E
BE
Orav
E J
EJ
Wilk
D
D
Weinberg
G A
GA
Nicchitta
J
J
Furuta
L
L
Cutroni
R
R
McIntosh
K
K
Burchett
S K
SK
Gorbach
S L
SL
D000886:Anthropometry; D001823:Body Composition / Q000187:drug effects*; D018791:CD4 Lymphocyte Count; D002648:Child; D002149:Energy Intake; D005260:Female; D006128:Growth / Q000187:drug effects*; D015658:HIV Infections / Q000188:drug therapy* / Q000503:physiopathology; D017320:HIV Protease Inhibitors / Q000494:pharmacology* / Q000627:therapeutic use; D015497:HIV-1; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D015999:Multivariate Analysis; D012044:Regression Analysis; D019562:Viral Load
D017320:HIV Protease Inhibitors