title: Growth Recovery Among HIV-infected Children Randomized to Lopinavir/Ritonavir or NNRTI-based Antiretroviral Therapy.
abstract: Diminished growth is highly prevalent among HIV-infected children and might be improved by antiretroviral therapy (ART). We examined growth recovery in a rural Ugandan cohort of HIV-infected children randomized to lopinavir/ritonavir (LPV/r) or non nucleoside reverse transcription inhibitor-based ART.
  
  
  
  HIV-infected children 2 months to 6 years of age were randomized to LPV/r- or non nucleoside reverse transcription inhibitor-based ART. Changes in weight-for-age (WAZ), height-for-age (HAZ) and weight-for-height Z-scores for 24 months were evaluated using generalized linear repeated measures models. Recovery from being underweight (WAZ<-2), stunted (HAZ<-2) and wasted (weight-for-height <-2) to Z-scores greater than -2 was also compared by arm using Kaplan-Meier survival and Cox proportional hazard modeling.
  
  
  
  A total of 129 children with median age of 3 years initiated therapy; 64 received LPV/r-based and 65 non nucleoside reverse transcription inhibitor-based ART (nevirapine: 36 and efavirenz: 29). The median (interquartile range) difference in growth measures between baseline and 24 months for LPV/r (n = 45) versus non nucleoside reverse transcription inhibitor-based therapy (n = 40) were as follows: WAZ, 0.47 (0.10, 1.62) versus 0.53 (0.03, 1.14) (P = 0.59) and HAZ, median 1.55 (0.78, 1.86) versus 1.19 (0.62, 1.65) (P = 0.23), respectively. ART regimen was not predictive of change in WAZ (β: -0.02, 95% confidence interval: -0.25, 0.20) or HAZ (β: 0.05, 95% confidence interval: -0.10, 0.19). The presence of confirmed virologic failure was not associated with growth.
  
  
  
  Most ART-naive children experienced recovery of both WAZ and HAZ over the 24 months after ART initiation, with no significant difference between those receiving LPV/r versus non nucleoside reverse transcriptase inhibitor-based ART. However, the persistence of median Z-scores below 0 underscores the need for additional strategies to improve growth outcomes in HIV+ African children.
authors: From the *Medical Research Council Unit The Gambia; †Infectious Diseases Research Collaboration, Kampala, Uganda; ‡Department of Medicine, University of California, San Francisco, California; §Division of Nutritional Sciences, Cornell University, Ithaca, New York; ¶Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda; and ‖Department of Pediatrics, University of California, San Francisco, California.
authors: Jane
authors: J
authors: Achan
authors: Abel
authors: A
authors: Kakuru
authors: Gloria
authors: G
authors: Ikilezi
authors: Florence
authors: F
authors: Mwangwa
authors: Albert
authors: A
authors: Plenty
authors: Edwin
authors: E
authors: Charlebois
authors: Sera
authors: S
authors: Young
authors: Diane
authors: D
authors: Havlir
authors: Moses
authors: M
authors: Kamya
authors: Theodore
authors: T
authors: Ruel
mesh_terms: D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D001827:Body Height / Q000502:physiology*; D001835:Body Weight / Q000502:physiology*; D002675:Child, Preschool; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D061466:Lopinavir / Q000627:therapeutic use*; D008297:Male; D019438:Ritonavir / Q000627:therapeutic use*
chemical_list: D044966:Anti-Retroviral Agents; D061466:Lopinavir; D019438:Ritonavir