title: Effect of Age at Antiretroviral Therapy Initiation on Catch-up Growth Within the First 24 Months Among HIV-infected Children in the IeDEA West African Pediatric Cohort.
abstract: BACKGROUND
  We described malnutrition and the effect of age at antiretroviral therapy (ART) initiation on catch-up growth over 24 months among HIV-infected children enrolled in the International epidemiologic Databases to Evaluate Aids West African paediatric cohort.
  
  
  METHODS
  Malnutrition was defined at ART initiation (baseline) by a Z score <-2 standard deviations, according to 3 anthropometric indicators: weight-for-age (WAZ) for underweight, height-for-age (HAZ) for stunting and weight-for-height/BMI-for-age (WHZ/BAZ) for wasting. Kaplan-Meier estimates for catch-up growth (Z score ≥-2 standard deviations) on ART, adjusted for gender, immunodeficiency and malnutrition at ART initiation, ART regimen, time period and country, were compared by age at ART initiation. Cox proportional hazards regression models determined predictors of catch-up growth on ART over 24 months.
  
  
  RESULTS
  Between 2001 and 2012, 2004 HIV-infected children <10 years of age were included. At ART initiation, 51% were underweight, 48% were stunted and 33% were wasted. The 24-month adjusted estimates for catch-up growth were 69% [95% confidence interval (CI): 57-80], 61% (95% CI: 47-70) and 90% (95% CI: 76-95) for WAZ, HAZ and WHZ/BAZ, respectively. Adjusted catch-up growth was more likely for children <5 years of age at ART initiation compared with children ≥5 years for WAZ, HAZ (P < 0.001) and WHZ/BAZ (P = 0.026).
  
  
  CONCLUSIONS
  Malnutrition among these children is an additional burden that has to be urgently managed. Despite a significant growth improvement after 24 months on ART, especially in children <5 years, a substantial proportion of children still never achieved catch-up growth. Nutritional care should be part of the global healthcare of HIV-infected children in sub-Saharan Africa.
authors.affiliation: From the *Inserm, Centre Inserm U897-Epidémiologie-Biostatistiques, Bordeaux, France; † ISPED, Centre Inserm U897-Epidémiologie-Biostatistiques, University of Bordeaux, Bordeaux, France; ‡Centre National Hospitalier Universitaire Hubert K. Maga, Cotonou, Bénin; §Hôpital des Enfants Albert Royer, Dakar, Sénégal; ¶Service Pédiatrie, Centre Hospitalo-Universitaire de Cocody, Abidjan, Côte d'Ivoire; ‖Hôpital pédiatrique, Centre Hospitalier Universitaire Charles de Gaulle, Ouagadougou, Burkina Faso; **Centre de Prise en charge, de Recherche et de Formation (CePReF), Abidjan, Côte d'Ivoire; ††Centre Hospitalier Universitaire de Tokoin, Lomé, Togo; ‡‡Hôpital Gabriel Toure, Bamako, Mali; §§CIRBA, Abidjan, Côte d'Ivoire; ¶¶Programme MTCT+, Abidjan, Côte d'Ivoire; ‖‖Korle Bu Hospital, Accra, Ghana; ***Service Pédiatrie, Centre Hospitalo-Universitaire de Yopougon, Abidjan, Côte d'Ivoire; and †††Regional IeDEA Coordination, PACCI, Abidjan, Côte d'Ivoire.
authors.forename: Julie
authors.initials: J
authors.lastname: Jesson
authors.forename: Sikiratou
authors.initials: S
authors.lastname: Koumakpaï
authors.forename: Ndeye R
authors.initials: NR
authors.lastname: Diagne
authors.forename: Madeleine
authors.initials: M
authors.lastname: Amorissani-Folquet
authors.forename: Fla
authors.initials: F
authors.lastname: Kouéta
authors.forename: Addi
authors.initials: A
authors.lastname: Aka
authors.forename: Koko
authors.initials: K
authors.lastname: Lawson-Evi
authors.forename: Fatoumata
authors.initials: F
authors.lastname: Dicko
authors.forename: Kouadio
authors.initials: K
authors.lastname: Kouakou
authors.forename: Touré
authors.initials: T
authors.lastname: Pety
authors.forename: Lorna
authors.initials: L
authors.lastname: Renner
authors.forename: Tanoh
authors.initials: T
authors.lastname: Eboua
authors.forename: Patrick A
authors.initials: PA
authors.lastname: Coffie
authors.forename: Sophie
authors.initials: S
authors.lastname: Desmonde
authors.forename: Valériane
authors.initials: V
authors.lastname: Leroy
mesh_terms: D017954:Africa South of the Sahara / Q000453:epidemiology; D000354:Africa, Western / Q000453:epidemiology; D000886:Anthropometry; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods*; D002648:Child; D002657:Child Development; D002675:Child, Preschool; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D044342:Malnutrition / Q000150:complications* / Q000453:epidemiology; D011446:Prospective Studies; D013997:Time Factors
chemical_list: D044966:Anti-Retroviral Agents