Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Nov 1;40(11):1004-1010.
doi: 10.1097/INF.0000000000003258.

Growth and Metabolic Changes After Antiretroviral Initiation in South African Children

Michela Masi-Leone  1 , Stephen Arpadi  2   3   4 , Chloe Teasdale  2   3 , Katharine A Yuengling  2 , Anthony Mutiti  2 , Mary Mogashoa  5 , Emilia D Rivadeneira  6 , Elaine J Abrams  2   3   4 , Jennifer Jao  7
Affiliations

Growth and Metabolic Changes After Antiretroviral Initiation in South African Children

Michela Masi-Leone et al. Pediatr Infect Dis J. .

Abstract

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.

PubMed Disclaimer

Conflict of interest statement

The authors have conflicts of interest to disclose.

Figures

FIGURE 1.
FIGURE 1.
LOESS plots of longitudinal changes in growth and lipids after ART initiation among South African children living with HIV initiating ART, PESS Study (N=241). ART=antiretroviral therapy, BMIZ=Body Mass Index Z-score, HDL=high density lipoprotein, LAZ=Length-for-age Z-score, LDL=low density lipoprotein, TC=total cholesterol, WAZ=Weight-for-age Z-score
See this image and copyright information in PMC

References

    1. Carr A, Samaras K, Thorisdottir A, et al. Diagnosis, prediction, and natural course of HIV-1 protease-inhibitor-associated lipodystrophy, hyperlipidaemia, and diabetes mellitus: a cohort study. Lancet. 1999;353:2093–2099. - PubMed
    1. Tassiopoulos K, Williams PL, Seage GR 3rd, et al.; International Maternal Pediatric Adolescent AIDS Clinical Trials 219C Team. Association of hypercholesterolemia incidence with antiretroviral treatment, including protease inhibitors, among perinatally HIV-infected children. J Acquir Immune Defic Syndr. 2008;47:607–614. - PMC - PubMed
    1. Jacobson DL, Patel K, Siberry GK, et al.; Pediatric HIV/AIDS Cohort Study. Body fat distribution in perinatally HIV-infected and HIV-exposed but uninfected children in the era of highly active antiretroviral therapy: outcomes from the Pediatric HIV/AIDS Cohort Study. Am J Clin Nutr. 2011;94:1485–1495. - PMC - PubMed
    1. Arpadi SM, Cuff PA, Horlick M, et al. Lipodystrophy in HIV-infected children is associated with high viral load and low CD4+ −lymphocyte count and CD4+ −lymphocyte percentage at baseline and use of protease inhibitors and stavudine. J Acquir Immune Defic Syndr. 2001;27:30–34. - PubMed
    1. Dzwonek AB, Lawson MS, Cole TJ, et al. Body fat changes and lipodystrophy in HIV-infected children: impact of highly active antiretroviral therapy. J Acquir Immune Defic Syndr. 2006;43:121–123. - PubMed

Publication types