Journal Article

Stunting and growth velocity of adolescents with perinatally acquired HIV: differential evolution for males and females. A multiregional analysis from the IeDEA global paediatric collaboration

McGowan, Catherine C, Sylla, Mariam, Kouadio, Kouakou, Leroy, Valériane, Kariminia, Azar, Vreeman, Rachel, Davies, Mary‐Ann, Ayaya, Samuel, Yotebieng, Marcel, Sawry, Shobna, Malasteste, Karen, Schomaker, Michael, Wati, Dewi K, Jesson, Julie, Mubiana‐Mbewe, Mwangelwa

2019

Overview

Introduction Stunting is a key issue for adolescents with perinatally acquired HIV (APH) that needs to be better understood. As part of the IeDEA multiregional consortium, we described growth evolution during adolescence for APH on antiretroviral therapy (ART). Methods We included data from sub‐Saharan Africa, the Asia‐Pacific, and the Caribbean, Central and South America regions collected between 2003 and 2016. Adolescents on ART, reporting perinatally acquired infection or entering HIV care before 10 years of age, with at least one height measurement between 10 and 16 years of age, and followed in care until at least 14 years of age were included. Characteristics at ART initiation and at 10 years of age were compared by sex. Correlates of growth defined by height‐for‐age z‐scores (HAZ) between ages 10 and 19 years were studied separately for males and females, using linear mixed models. Results Overall, 8737 APH were included, with 46% from Southern Africa. Median age at ART initiation was 8.1 years (interquartile range (IQR) 6.1 to 9.6), 50% were females, and 41% were stunted (HAZ<−2 SD) at ART initiation. Males and females did not differ by age and stunting at ART initiation, CD4 count over time or retention in care. At 10 years of age, 34% of males were stunted versus 39% of females (p < 0.001). Females had better subsequent growth, resulting in a higher prevalence of stunting for males compared to females by age 15 (48% vs. 25%) and 18 years (31% vs. 15%). In linear mixed models, older age at ART initiation and low CD4 count were associated with poor growth over time (p < 0.001). Those stunted at 10 years of age or at ART initiation had the greatest growth improvement during adolescence. Conclusions Prevalence of stunting is high among APH worldwide. Substantial sex‐based differences in growth evolution during adolescence were observed in this global cohort, which were not explained by differences in age of access to HIV care, degree of immunosuppression or region. Other factors influencing growth differences in APH, such as differences in pubertal development, should be better documented, to guide further research and inform interventions to optimize growth and health outcomes among APH.

• Publisher: International AIDS Society,John Wiley & Sons, Inc,BioMed Central (2008-2012) ; International Aids Society (2008-) ; Wiley (2017-),John Wiley and Sons Inc
• Subject: Acquired immune deficiency syndrome / Adolescence / Adolescent / Adolescent Development / Adolescents / Age / AIDS / Analysis / Antiretroviral agents / Antiviral agents / Child / Child development / Children & youth / Childrens health / Chronic illnesses / Cohort analysis / Cohort Studies / Collaboration / Consortia / developing countries / Development and progression / Drug abuse / Drug therapy / Epidemiology / Female / Global Health / Growth / Growth Disorders / Health aspects / HIV / HIV infection / HIV Infections - complications / HIV Infections - epidemiology / Human health and pathology / Human immunodeficiency virus / Humans / Infections / Infectious diseases / Life Sciences / Male / Malnutrition / Maternal-fetal exchange / Mental health / Mortality / Patient outcomes / Pediatrics / Population / Prevalence / Risk factors / Santé publique et épidémiologie / Sex Characteristics / Sexually transmitted diseases / STD / stunting / Teenagers / Time Factors