title: Younger age at HAART initiation is associated with more rapid growth reconstitution.
abstract: OBJECTIVE
  Patterns of growth following highly active antiretroviral therapy (HAART) administration among children are not well defined. The objective of this study was to determine rates and predictors of growth reconstitution among children on HAART.
  
  
  METHODS
  A study was conducted among HIV-1-infected children initiating HAART at an HIV treatment clinic in Kenya. Kaplan-Meier survival curves and Cox proportional hazards regression models compared catch-up growth (Z-score ≥ 0) at 12 months post-HAART. Multivariate linear mixed-effects models determined rates and predictors of growth following HAART.
  
  
  RESULTS
  One hundred and seventy-three HIV-1-infected children initiated HAART with a median age of 4.7 years [interquartile range (IQR) 2.4, 7.0]. At baseline, children below 3 years had lower weight-for-age (WAZ) and weight-for-height (WHZ) Z-scores than children 3-5 and 6-10 years (WAZ: P = 0.03; WHZ: P = 0.006). Adjusting for baseline growth, children below 3 years were two to three-fold more likely to attain population age-norms (Z-score = 0) than 6-10 years (WAZ: P = 0.055; WHZ: P = 0.005) at 12 months post-HAART. After adjustment, children below 3 years had higher increases in WAZ and WHZ following HAART than 6-10 years (WAZ: P = 0.006; WHZ: P = 0.005). Children at WHO stage at least 3 at baseline experienced more rapid WHZ reconstitution (P = 0.002). Food supplementation while on HAART was associated with increased monthly gains in weight indices (WAZ: P = 0.001; WHZ: P = 0.005), and multivitamins were associated with greater increases in height (P < 0.01).
  
  
  CONCLUSIONS
  Following HAART initiation, younger children had more rapid catch-up to the population-average weight of their peers than older children, demonstrating growth benefit of earlier HAART. In addition to HAART, food supplementation and multivitamins may also accelerate growth reconstitution.
authors.affiliation: Department of Epidemiology, University of Washington, Seattle, Washington, USA. mcgrathc@u.washington.edu
authors.forename: Christine J
authors.initials: CJ
authors.lastname: McGrath
authors.forename: Michael H
authors.initials: MH
authors.lastname: Chung
authors.forename: Barbra A
authors.initials: BA
authors.lastname: Richardson
authors.forename: Sarah
authors.initials: S
authors.lastname: Benki-Nugent
authors.forename: Danson
authors.initials: D
authors.lastname: Warui
authors.forename: Grace C
authors.initials: GC
authors.lastname: John-Stewart
mesh_terms: D000367:Age Factors; D023241:Antiretroviral Therapy, Highly Active; D001827:Body Height / Q000187:drug effects; D001835:Body Weight / Q000187:drug effects; D002648:Child; D002657:Child Development / Q000187:drug effects*; D002675:Child, Preschool; D019587:Dietary Supplements; D005260:Female; D015658:HIV Infections / Q000178:diet therapy / Q000188:drug therapy* / Q000401:mortality; D015497:HIV-1; D006801:Humans; D053208:Kaplan-Meier Estimate; D007630:Kenya; D008297:Male; D016896:Treatment Outcome; D019562:Viral Load