title: Growth in Virologically Suppressed HIV-Positive Children on Antiretroviral Therapy: Individual and Population-level References.
abstract: BACKGROUND
  Combination antiretroviral therapy (ART) suppresses viral replication in HIV-infected children. The growth of virologically suppressed children on ART has not been well documented. We aimed to develop dynamic reference curves for weight-for-age Z scores (WAZ) and height-for-age Z scores (HAZ).
  
  
  METHODS
  Children aged <11 years at ART initiation with continuously undetectable viral loads (<400 copies/mL) treated at 7 South African ART programs with routine viral load monitoring were included. We used multilevel models to define trajectories of WAZ and HAZ up to 3 years and developed a web application to monitor trajectories in individual children.
  
  
  RESULTS
  A total of 4876 children were followed for 7407 person-years. Analyses were stratified by baseline Z scores and age, which were the most important predictors of growth response. The youngest children showed the most pronounced increase in weight and height initially but catch-up growth stagnated after 1-2 years. Three years after starting ART, WAZ ranged from -2.2 [95% prediction interval (PrI), -5.6 to 0.8] in children with baseline age >5 years and Z score less than -3 to 0.0 (95% PrI, -2.7 to 2.4) in children with baseline age <2 years and WAZ greater than -1. For HAZ, the corresponding range was -2.3 (95% PrI, -4.9 to 0.3) in children with baseline age >5 years and Z score less than -3 to 0.3 (95% PrI, -3.1 to 3.4) in children with baseline age 2-5 years and HAZ greater than -1.
  
  
  CONCLUSIONS
  We have developed an online tool to calculate reference trajectories in fully suppressed children. The web application could help to define "optimal" growth response and identify children with treatment failure.
authors.affiliation: From the *Institute of Social and Preventive Medicine (ISPM), University of Bern, Switzerland; †School of Public Health and Family Medicine, University of Cape Town, South Africa; ‡Leuven Institute for Research on Information Systems, KU Leuven, Belgium; §Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa; ¶Wits Reproductive Health and HIV Institute (Harriet Shezi Children's Clinic, Chris Hani Baragwanath Hospital, Soweto), University of Witwatersrand, Johannesburg, South Africa; ‖Tygerberg Academic Hospital, University of Stellenbosch, Stellenbosch, South Africa; **Empilweni Services and Research Unit (Rahima Moosa Mother and Child Hospital, Johannesburg) and University of Witwatersrand, Johannesburg, South Africa; ††Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Somkhele, South Africa; ‡‡Médecins Sans Frontières (MSF) South Africa, Khayelitsha, Cape Town, South Africa; §§Sinikithemba Clinic, McCord Hospital, Johannesburg, South Africa; and ¶¶Kheth'Impilo, Cape Town, South Africa.
authors.forename: Olivia
authors.initials: O
authors.lastname: Keiser
authors.forename: Nello
authors.initials: N
authors.lastname: Blaser
authors.forename: Mary-Ann
authors.initials: MA
authors.lastname: Davies
authors.forename: Patrick
authors.initials: P
authors.lastname: Wessa
authors.forename: Brian
authors.initials: B
authors.lastname: Eley
authors.forename: Harry
authors.initials: H
authors.lastname: Moultrie
authors.forename: Helena
authors.initials: H
authors.lastname: Rabie
authors.forename: Karl-Günther
authors.initials: KG
authors.lastname: Technau
authors.forename: James
authors.initials: J
authors.lastname: Ndirangu
authors.forename: Daniela
authors.initials: D
authors.lastname: Garone
authors.forename: Janet
authors.initials: J
authors.lastname: Giddy
authors.forename: Ashraf
authors.initials: A
authors.lastname: Grimwood
authors.forename: Thomas
authors.initials: T
authors.lastname: Gsponer
authors.forename: Matthias
authors.initials: M
authors.lastname: Egger
mesh_terms: D019380:Anti-HIV Agents / Q000494:pharmacology / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D005260:Female; D057238:Growth Charts; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology / Q000503:physiopathology / Q000821:virology; D015497:HIV-1 / Q000187:drug effects; D006801:Humans; D007223:Infant; D008297:Male; D019562:Viral Load / Q000187:drug effects; D065927:Waist-Height Ratio
chemical_list: D019380:Anti-HIV Agents