The influence of nutritional status on the response to HAART in HIV-infected children in South Africa.
BACKGROUND
While the impact of HAART on growth in children is well established, the influence of prior nutritional status on the response to HAART is not well known.


METHODS
A retrospective study was conducted on 120 children in South Africa. Patients were divided into 3 groups (normal, moderately underweight, and severely underweight) based on weight-for-age z-scores (WAZ). Age, weight, height, CD4 cell percentage, and viral load were recorded at initiation of HAART and after 24 months of therapy. Data were analyzed using t-tests, chi tests, and one-way ANOVA.


RESULTS
At baseline, 58% of children were normal weight, 18% moderately underweight, and 23% severely underweight. After 24 months of HAART, WAZ improved significantly in moderately and severely underweight patient groups compared with the normal group. Height-for-age z-scores (HAZ) increased in all 3 groups with severely underweight children gaining more height than normal weight counterparts. Weight-for-height z-scores (WHZ) normalized in the severely underweight group. Mean CD4 cell percentages increased significantly in all 3 groups while viral loads decreased significantly in all groups with no differences among the groups at the end of 24 months of therapy. Of the entire cohort, 75% achieved undetectable HIV RNA viral loads.


CONCLUSIONS
Underlying malnutrition does not adversely affect growth, immunologic or virologic response to HAART in HIV-infected children. Underweight children exhibit an equally robust response to treatment as their well-nourished peers.
Naidoo
Reené
R
Department of Pediatrics, Georgetown University Hospital, Washington, DC 20007, USA.
Rennert
Wolfgang
W
Lung
Audrey
A
Naidoo
Kimesh
K
McKerrow
Neil
N
D000367:Age Factors; D000704:Analysis of Variance; D019380:Anti-HIV Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D016009:Chi-Square Distribution; D015362:Child Nutrition Disorders / Q000453:epidemiology / Q000821:virology*; D002675:Child, Preschool; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D007223:Infant; D012189:Retrospective Studies; D013019:South Africa / Q000453:epidemiology; D013851:Thinness / Q000453:epidemiology / Q000821:virology; D016896:Treatment Outcome; D019562:Viral Load
D019380:Anti-HIV Agents