title: Growth response to antiretroviral treatment in HIV-infected children: a cohort study from Lilongwe, Malawi.
abstract: OBJECTIVE
  Malnutrition is common in HIV-infected children in Africa and an indication for antiretroviral treatment (ART). We examined anthropometric status and response to ART in children treated at a large public-sector clinic in Malawi.
  
  
  METHODS
  All children aged <15 years who started ART between January 2001 and December 2006 were included and followed until March 2008. Weight and height were measured at regular intervals from 1 year before to 2 years after the start of ART. Sex- and age-standardized z-scores were calculated for weight-for-age (WAZ) and height-for-age (HAZ). Predictors of growth were identified in multivariable mixed-effect models.
  
  
  RESULTS
  A total of 497 children started ART and were followed for 972 person-years. Median age (interquartile range; IQR) was 8 years (4-11 years). Most children were underweight (52% of children), stunted (69%), in advanced clinical stages (94% in WHO stages 3 or 4) and had severe immunodeficiency (77%). After starting ART, median (IQR) WAZ and HAZ increased from -2.1 (-2.7 to -1.3) and -2.6 (-3.6 to -1.8) to -1.4 (-2.1 to -0.8) and -1.8 (-2.4 to -1.1) at 24 months, respectively (P < 0.001). In multivariable models, baseline WAZ and HAZ scores were the most important determinants of growth trajectories on ART.
  
  
  CONCLUSIONS
  Despite a sustained growth response to ART among children remaining on therapy, normal values were not reached. Interventions leading to earlier HIV diagnosis and initiation of treatment could improve growth response.
authors.affiliation: Ministry of Health and Lighthouse Trust at Kamuzu Central Hospital, Lilongwe, Malawi.
authors.forename: Ralf
authors.initials: R
authors.lastname: Weigel
authors.forename: Sam
authors.initials: S
authors.lastname: Phiri
authors.forename: Fred
authors.initials: F
authors.lastname: Chiputula
authors.forename: Joe
authors.initials: J
authors.lastname: Gumulira
authors.forename: Martin
authors.initials: M
authors.lastname: Brinkhof
authors.forename: Thomas
authors.initials: T
authors.lastname: Gsponer
authors.forename: Hannock
authors.initials: H
authors.lastname: Tweya
authors.forename: Matthias
authors.initials: M
authors.lastname: Egger
authors.forename: Olivia
authors.initials: O
authors.lastname: Keiser
mesh_terms: D000886:Anthropometry / Q000379:methods; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods; D001827:Body Height / Q000187:drug effects; D001835:Body Weight / Q000187:drug effects; D018791:CD4 Lymphocyte Count; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003906:Developing Countries; D005260:Female; D006128:Growth / Q000187:drug effects*; D006130:Growth Disorders / Q000503:physiopathology / Q000821:virology*; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000276:immunology / Q000503:physiopathology; D006801:Humans; D008295:Malawi; D008297:Male; D044342:Malnutrition / Q000150:complications / Q000503:physiopathology; D011379:Prognosis; D016896:Treatment Outcome
chemical_list: D019380:Anti-HIV Agents