Global variations in pubertal growth spurts in adolescents living with perinatal HIV

Abstract

Objective: To describe pubertal growth spurts among adolescents living with perinatally acquired HIV (ALWPHIV) on antiretroviral therapy (ART).

Design: Observational data collected from 1994 to 2015 in the CIPHER global cohort collaboration.

Methods: ALWPHIV who initiated ART age less than 10 years with at least four height measurements age at least 8 years were included. Super Imposition by Translation And Rotation (SITAR) models, with parameters representing timing and intensity of the growth spurt, were used to describe growth, separately by sex. Associations between region, ART regimen, age, height-for-age (HAZ), and BMI-for-age z -scores (BMIz) at ART initiation (baseline) and age 10 years, and SITAR parameters were explored.

Results: Four thousand seven hundred and twenty-three ALWPHIV were included: 51% from East and Southern Africa (excluding Botswana and South Africa), 17% Botswana and South Africa, 6% West and Central Africa, 11% Europe and North America, 11% Asia-Pacific, and 4% Central, South America, and Caribbean. Growth spurts were later and least intense in sub-Saharan regions. In females, older baseline age and lower BMIz at baseline were associated with later and more intense growth spurts; lower HAZ was associated with later growth spurts. In males, older baseline age and lower HAZ were associated with later and less intense growth spurts; however, associations between baseline HAZ and timing varied by age. Lower HAZ and BMIz at 10 years were associated with later and less intense growth spurts in both sexes.

Conclusion: ALWPHIV who started ART at older ages or already stunted were more likely to have delayed pubertal growth spurts. Longer-term follow-up is important to understand the impact of delayed growth.

Fig. 1

Flow diagram of selection of the adolescents living with HIV included in the puberty growth spurt analysis.

Fig. 2

Mean height (left panel) and growth velocity (right panel) curves estimated using SITAR models stratified by region and sex in the CIPHER global cohort collaboration.

Fig. 3

Female pubertal growth: multivariable associations between region, age, height-for-age z-score and BMI-for-age z-score at antiretroviral therapy initiation and the timing and intensity of the pubertal growth spurt in females in the CIPHER global cohort collaboration.

Fig. 4

Male pubertal growth: Multivariable associations between region, age, height-for-age z-score and BMI-for-age z-score at antiretroviral therapy initiation and the timing and intensity of the pubertal growth spurt in males in the CIPHER global cohort collaboration.