Clinical and contextual determinants of anthropometric failure at baseline and longitudinal improvements after starting antiretroviral treatment among South African children.
OBJECTIVE
To describe baseline nutritional anthropometry and its determinants in a cohort of children commencing HAART, and subsequent longitudinal anthropometric trajectories over 2 years.


METHODS
Prospective observational study in a prepubertal cohort of children commencing HAART in Durban, South Africa.


RESULTS
Among 151 children with a median baseline age of 61.3 months (IQR 29.6, 90.1), prevalence of stunting was 54% (95% CI 46, 62) and of underweight, 37% (95% CI 29, 45). There was high prevalence of preceding respiratory and diarrhoeal comorbidities, which were associated with poorer anthropometry. There were significant improvements in height, weight and mid-upper-arm circumference z-scores after initiation of HAART regardless of preceding comorbidities. Stunted children remained shorter on average after 24 months, but younger children had better catch-up. Children who eventually died had persistently worse anthropometry. Children who were exposed to improved programs for prevention of mother-to-child transmission (PMTCT) were younger and had more severe growth impairments at baseline.


CONCLUSIONS
Anthropometric status of children on HAART is influenced by age, preceding comorbidities, and by programmatic factors. With improved PMTCT programs, infants who would previously have died in infancy are now surviving to commence HAART. Poor outcomes are preceded by persistent anthropometric failure on HAART reaffirming the need for growth velocity monitoring.
Department of Paediatrics and Child Health, University of KwaZulu-Natal, Congella, South Africa. chhagan@ukzn.ac.za
Meera K
MK
Chhagan
Shuaib
S
Kauchali
Jan
J
Van den Broeck
D023241:Antiretroviral Therapy, Highly Active; D001724:Birth Weight; D001837:Body Weights and Measures; D018791:CD4 Lymphocyte Count; D002648:Child; D002675:Child, Preschool; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000503:physiopathology*; D006801:Humans; D007223:Infant; D008137:Longitudinal Studies; D008297:Male; D015995:Prevalence; D011446:Prospective Studies; D013019:South Africa / Q000453:epidemiology; D013851:Thinness