title: Growth Patterns of HIV Infected Indian Children in Response to ART: A Clinic Based Cohort Study.
abstract: OBJECTIVE
  To describe catch-up growth after antiretroviral therapy (ART) initiation among children living with human immunodeficiency virus (CLHIV), attending a private clinic in India.
  
  
  METHODS
  This is a retrospective analysis of data of CLHIV attending Prayas clinic, Pune, India. Height and weight z scores (HAZ, WAZ) were calculated using WHO growth charts. Catch-up growth post-ART was assessed using a mixed method model in cases where baseline and at least one subsequent follow-up HAZ/WAZ were available. STATA 12 was used for statistical analysis.
  
  
  RESULTS
  During 1998 to 2011, 466 children were enrolled (201 girls and 265 boys; median age = 7 y). A total of 302 children were ever started on ART; of which 73 and 76 children were included for analysis for catch up growth in WAZ and HAZ respectively. Median WAZ and HAZ increased from -2.14 to -1.34 (p = 0.007) and -2.42 to -1.94 (p = 0.34), respectively, 3 y post ART. Multivariable analysis using mixed model (adjusted for gender, guardianship, baseline age, baseline WAZ/HAZ, baseline and time varying WHO clinical stage) showed gains in WAZ (coef = 0.2, 95 % CI: -0.06 to 0.46) and HAZ (coef = 0.49, 95 % CI: 0.21 to 0.77) with time on ART. Lower baseline WAZ/HAZ and older age were associated with impaired catch-up growth. Children staying in institutions and with baseline advanced clinical stage showed higher gain in WAZ.
  
  
  CONCLUSIONS
  The prevalence of stunting and underweight was high at ART initiation. Sustained catch-up growth was seen with ART. The study highlights the benefit of early ART in achieving normal growth in CLHIV.
authors.affiliation: Prayas, Karve Road Corner, Deccan Gymkhana, Pune, 411004, India, rituparchure@gmail.com.
authors.forename: Ritu S
authors.initials: RS
authors.lastname: Parchure
authors.forename: Vinay V
authors.initials: VV
authors.lastname: Kulkarni
authors.forename: Trupti S
authors.initials: TS
authors.lastname: Darak
authors.forename: Rahul
authors.initials: R
authors.lastname: Mhaskar
authors.forename: Branko
authors.initials: B
authors.lastname: Miladinovic
authors.forename: Patricia J
authors.initials: PJ
authors.lastname: Emmanuel
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D000886:Anthropometry / Q000379:methods; D044966:Anti-Retroviral Agents / Q000008:administration & dosage*; D001827:Body Height; D001835:Body Weight; D018791:CD4 Lymphocyte Count / Q000706:statistics & numerical data; D002648:Child; D061345:Early Medical Intervention; D005260:Female; D057238:Growth Charts; D006130:Growth Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D015658:HIV Infections / Q000150:complications / Q000276:immunology; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D063868:Patient Outcome Assessment; D015995:Prevalence; D013851:Thinness / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D061665:Time-to-Treatment
chemical_list: D044966:Anti-Retroviral Agents