Impact of HAART on survival, weight gain and resting energy expenditure in HIV-1-infected children in India.
BACKGROUND
In resource-limited countries, use of highly active antiretroviral therapy (HAART) in HIV-infected children is still poorly documented in terms of impact on survival, the immune system and growth. Since the availability of HAART, nutrition of HIV-infected children has been neglected.


OBJECTIVE
To evaluate the effect of HAART on survival and immune response in HIV-infected children and to investigate the response to nutritional support.


METHODS
In December, 2002 a cohort study was carried out on vertically HIV-1-infected children and was observed longitudinally for CD4(+) T-cell count, antiretroviral treatment and weight until 31 December 2007. Z-scores were calculated for CD4(+) T-cell count to account for age-related differences. Nutritional supplementation was given to all the HIV-infected children and resting energy expenditure (REE) was calculated. Mortality rates were also calculated for the perinatally infected children followed up at the HIV clinic.


RESULTS
A total of 180 children were assessed, 100 (56%) of whom were on HAART. Baseline body mass index was lower in the HAART group (p<0.05). Median duration of survival from date of diagnosis was 15.1 years. Those who received HAART survived significantly longer. The average annual mortality rate was 1.2% during 2005-2006. During HAART, a CD4 Z-score increase of 1 SD was associated with a 0.35 increase in body weight Z-score (p<0.001). The increase in daily energy intake owing to nutritional supplementation was associated with increase in weight Z-score in both the no-HAART and HAART group. REE was independently associated with weight change in the models which tested association of changes in CD4(+) T-cell Z-score and daily REE/kg body weight with changes in body weight Z-score in both the HAART and no-HAART group and then separately in the two groups (p<0.001).


CONCLUSIONS
Survival rates of children improved which correlated with an increase in CD4(+) T-cell count concurrent with the expanded use of HAART. HAART had a positive effect on growth in HIV-1-infected children. Nutrition supplementation improved the health of children in both the no-HAART and HAART groups.
Banerjee
T
T
Department of Statistics, University of Delhi, Delhi, India. tanushree@aidsresearcher.org
Pensi
T
T
Banerjee
D
D
Grover
G
G
D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D002648:Child; D002664:Child Nutritional Physiological Phenomena / Q000187:drug effects; D002675:Child, Preschool; D015331:Cohort Studies; D004734:Energy Metabolism / Q000187:drug effects*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000401:mortality* / Q000821:virology; D015497:HIV-1 / Q000302:isolation & purification; D006801:Humans; D007194:India; D007223:Infant; D018445:Infectious Disease Transmission, Vertical; D008137:Longitudinal Studies; D008297:Male; D015430:Weight Gain / Q000187:drug effects*
D019380:Anti-HIV Agents