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Failure to thrive in HIV-infected children: incidence, prevalence, and clinical correlates
J A Myhre1, E G Chadwick, R Yogev
1Department of Pediatrics, Children's Memorial Hospital, Northwestern University Medical School, Chicago, Illinois 60614, USA.
Insights
Failure to thrive in children with HIV is common, especially in severe cases. Comprehensive care, including nutrition and antiretroviral therapy, helps improve weight gain and reduce its incidence.
Area of Science:
- Pediatrics
- Infectious Diseases
- Clinical Nutrition
Background:
- Failure to thrive is a significant complication in pediatric acquired immunodeficiency syndrome (AIDS).
- Understanding its incidence, prevalence, and associated factors is crucial for effective management.
- Previous reports indicate a high occurrence of failure to thrive in HIV-infected children.
Purpose of the Study:
- To document the incidence, prevalence, and clinical correlates of failure to thrive in a cohort of HIV-infected children.
- To assess the impact of comprehensive care on failure to thrive outcomes.
- To compare current findings with previous literature on pediatric HIV failure to thrive.
Main Methods:
- Retrospective study of 97 HIV-infected children over an 8-year period.
- Failure to thrive defined as body weight for height age ≤ 90%.
- Analysis of clinical correlates including Centers for Disease Control (CDC) class and CD4 cell counts.
Main Results:
- Cumulative incidence of failure to thrive was 38% (37/97), with a prevalence of 14% (13/97).
- In severe symptomatic HIV infection (CDC class C), incidence was 67% (22/33) and prevalence 27% (9/33).
- CDC class C and low CD4 cell counts correlated with failure to thrive; nutritional therapy and zidovudine (AZT) were associated with weight gain.
Conclusions:
- The incidence and prevalence of failure to thrive in this cohort are lower than previously reported.
- Comprehensive care clinics offering nutritional support, opportunistic infection treatment, and antiretroviral therapy are effective.
- Integrated care models are likely to further reduce failure to thrive in children with HIV.
Abstract:
"Failure to thrive" is a frequent component of the acquired immunodeficiency syndrome (AIDS) in childhood. This retrospective study was conducted to document the incidence, prevalence, and clinical correlates of "failure to thrive" in a cohort of 97 HIV-infected children seen at a large urban teaching hospital over an 8-year period. "Failure to thrive" was defined as percent of body weight for height age < or = 90%. The cumulative incidence of failure to thrive in our cohort was 37/97 (38%), with a current prevalence of 13/97 (14%). When 33 patients with severe symptomatic HIV infection [Centers for Disease Control (CDC) class C] were analyzed separately, the cumulative incidence rose to 22/33 (67%) and current prevalence to 9/33 (27%). CDC class C correlated with failure to thrive (p < 0.001), as did absolute CD4 cell count more than two standard deviations below the mean for age (p < 0.001). Neither the mode of acquisition of HIV infection nor the presence of HIV antigenemia correlated with failure to thrive. During follow-up, 34/37 patients with failure to thrive gained weight; in 17 this was associated with specific nutritional therapy. Treatment with zidovudine (AZT) was also associated with a significant weight gain (p < 0.01). The incidence and prevalence of failure to thrive in our cohort are lower than in previous reports. We conclude that enrollment of HIV-infected children in a comprehensive clinic providing nutritional evaluation, supplemental feeding, treatment of opportunistic infections, antiretroviral medications, and psychosocial support will likely continue to reduce the incidence and prevalence of "failure to thrive."