TY - JOUR
T1 - Growth and Metabolic Changes after Antiretroviral Initiation in South African Children
AU - Masi-Leone, Michela
AU - Arpadi, Stephen
AU - Teasdale, Chloe
AU - Yuengling, Katharine A.
AU - Mutiti, Anthony
AU - Mogashoa, Mary
AU - Rivadeneira, Emilia D.
AU - Abrams, Elaine J.
AU - Jao, Jennifer
N1 - Funding Information:
This work was supported by the President’s Emergency Plan for AIDS Relief (PEPFAR) through the Centers for Disease Control and Prevention (CDC) under the terms of Cooperative Agreement Numbers 5U62PS223540 and 5U2GPS001537.
Funding Information:
This work was supported by the President? s Emergency Plan for AIDS Relief (PEPFAR) through the Centers for Disease Control and Prevention (CDC) under the terms of Cooperative Agreement Numbers 5U62PS223540 and 5U2GPS001537.
Publisher Copyright:
© 2021 Lippincott Williams and Wilkins. All rights reserved.
PY - 2021/11/1
Y1 - 2021/11/1
N2 - Background: Poor growth and metabolic disturbances remain concerns for children living with HIV (CLHIV). We describe the impact of viral load (VL) on growth and lipid outcomes in South African CLHIV < 12 years initiating World Health Organization recommended first-line antiretroviral therapy (ART) from 2012 to 2015. Methods: Z scores for length-for-age (LAZ), weight-for-age (WAZ) and body mass index-for-age were calculated. Lipids (total cholesterol, low-density lipoprotein and high-density lipoprotein) were measured. Hemoglobin A1C ≥ 5.8 was defined as at risk for type 2 diabetes. Mixed effects models were used to assess the association of VL at ART initiation with Z scores and lipids over time. Results: Of 241 CLHIV, 151 (63%) were < 3 years initiating LPV/r-based ART and 90 (37%) were ≥ 3 years initiating EFV-based ART. Among CLHIV < 3 years, higher VL at ART initiation was associated with lower mean LAZ (ß : -0.30, P=0.03), WAZ (ß : -0.32, P=0.01) and low-density lipoprotein (ß : -6.45, P=0.03) over time. Among CLHIV ≥ 3, a log 10 increase in pretreatment VL was associated with lower mean LAZ (ß : -0.29, P=0.07) trending towards significance and lower WAZ (ß : -0.32, P=0.05) as well as with more rapid increases in LAZ (ß : 0.14 per year, P=0.01) and WAZ (ß : 0.19 per year, P=0.04). Thirty percent of CLHIV were at risk for type 2 diabetes at ART initiation. Conclusions: CLHIV initiating ART < 3 years exhibited positive gains in growth and lipids, though high viremia at ART initiation was associated with persistently low growth and lipids, underscoring the need for early diagnosis and rapid treatment initiation. Future studies assessing the long-term cardiometabolic impact of these findings are warranted.
AB - Background: Poor growth and metabolic disturbances remain concerns for children living with HIV (CLHIV). We describe the impact of viral load (VL) on growth and lipid outcomes in South African CLHIV < 12 years initiating World Health Organization recommended first-line antiretroviral therapy (ART) from 2012 to 2015. Methods: Z scores for length-for-age (LAZ), weight-for-age (WAZ) and body mass index-for-age were calculated. Lipids (total cholesterol, low-density lipoprotein and high-density lipoprotein) were measured. Hemoglobin A1C ≥ 5.8 was defined as at risk for type 2 diabetes. Mixed effects models were used to assess the association of VL at ART initiation with Z scores and lipids over time. Results: Of 241 CLHIV, 151 (63%) were < 3 years initiating LPV/r-based ART and 90 (37%) were ≥ 3 years initiating EFV-based ART. Among CLHIV < 3 years, higher VL at ART initiation was associated with lower mean LAZ (ß : -0.30, P=0.03), WAZ (ß : -0.32, P=0.01) and low-density lipoprotein (ß : -6.45, P=0.03) over time. Among CLHIV ≥ 3, a log 10 increase in pretreatment VL was associated with lower mean LAZ (ß : -0.29, P=0.07) trending towards significance and lower WAZ (ß : -0.32, P=0.05) as well as with more rapid increases in LAZ (ß : 0.14 per year, P=0.01) and WAZ (ß : 0.19 per year, P=0.04). Thirty percent of CLHIV were at risk for type 2 diabetes at ART initiation. Conclusions: CLHIV initiating ART < 3 years exhibited positive gains in growth and lipids, though high viremia at ART initiation was associated with persistently low growth and lipids, underscoring the need for early diagnosis and rapid treatment initiation. Future studies assessing the long-term cardiometabolic impact of these findings are warranted.
KW - body mass index
KW - cholesterol
KW - viral load
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U2 - 10.1097/INF.0000000000003258
DO - 10.1097/INF.0000000000003258
M3 - Article
C2 - 34292268
AN - SCOPUS:85117383860
VL - 40
SP - 1004
EP - 1010
JO - Pediatric Infectious Disease Journal
JF - Pediatric Infectious Disease Journal
SN - 0891-3668
IS - 11
ER -