title: Variability of growth in children starting antiretroviral treatment in southern Africa.
abstract: BACKGROUND
  Poor growth is an indication for antiretroviral therapy (ART) and a criterion for treatment failure. We examined variability in growth response to ART in 12 programs in Malawi, Zambia, Zimbabwe, Mozambique, and South Africa.
  
  
  METHODS
  Treatment naïve children aged <10 years were included. We calculated weight for age z scores (WAZs), height for age z scores (HAZs), and weight for height z scores (WHZs) up to 3 years after starting ART, by using the World Health Organization standards. Multilevel regression models were used.
  
  
  RESULTS
  A total of 17990 children (range, 238-8975) were followed for 36181 person-years. At ART initiation, most children were underweight (50%) and stunted (66%). Lower baseline WAZ, HAZ, and WHZ were the most important determinants of faster catch-up growth on ART. WAZ and WHZ increased rapidly in the first year and stagnated or reversed thereafter, whereas HAZ increased continuously over time. Three years after starting ART, WAZ ranged from -2.80 (95% confidence interval [CI]: -3.66 to -2.02) to -1.98 (95% CI: -2.41 to -1.48) in children with a baseline z score < -3 and from -0.79 (95% CI: -1.62 to 0.02) to 0.05 (95% CI: -0.42 to 0.51) in children with a baseline WAZ ≥ -1. For HAZ, the corresponding range was -2.33 (95% CI: -2.62 to -2.02) to -1.27 (95% CI: -1.58 to -1.00) for baseline HAZ < -3 and -0.24 (95% CI: -0.56 to 0.15) to 0.84 (95% CI: 0.53 to 1.16) for HAZ ≥ -1.
  
  
  CONCLUSIONS
  Despite a sustained growth response and catch-up growth in children with advanced HIV disease treated with ART, normal weights and heights are not achieved over 3 years of ART.
authors.affiliation: Institute of Social and Preventive Medicine (ISPM), University of Bern, Finkenhubelweg 11, CH-3012 Bern, Switzerland.
authors.forename: Thomas
authors.initials: T
authors.lastname: Gsponer
authors.forename: Ralf
authors.initials: R
authors.lastname: Weigel
authors.forename: Mary-Ann
authors.initials: MA
authors.lastname: Davies
authors.forename: Carolyn
authors.initials: C
authors.lastname: Bolton
authors.forename: Harry
authors.initials: H
authors.lastname: Moultrie
authors.forename: Paula
authors.initials: P
authors.lastname: Vaz
authors.forename: Helena
authors.initials: H
authors.lastname: Rabie
authors.forename: Karl
authors.initials: K
authors.lastname: Technau
authors.forename: James
authors.initials: J
authors.lastname: Ndirangu
authors.forename: Brian
authors.initials: B
authors.lastname: Eley
authors.forename: Daniela
authors.initials: D
authors.lastname: Garone
authors.forename: Maureen
authors.initials: M
authors.lastname: Wellington
authors.forename: Janet
authors.initials: J
authors.lastname: Giddy
authors.forename: Jochen
authors.initials: J
authors.lastname: Ehmer
authors.forename: Matthias
authors.initials: M
authors.lastname: Egger
authors.forename: Olivia
authors.initials: O
authors.lastname: Keiser
mesh_terms: D000353:Africa, Southern; D019380:Anti-HIV Agents / Q000494:pharmacology / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006128:Growth / Q000187:drug effects*; D006130:Growth Disorders / Q000209:etiology*; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D008297:Male; D015233:Models, Statistical; D012044:Regression Analysis; D013851:Thinness / Q000209:etiology*; D016896:Treatment Outcome
chemical_list: D019380:Anti-HIV Agents