Growth in human immunodeficiency virus type 1-infected children treated with protease inhibitors

Area of Science:

• Pediatric Infectious Diseases
• Clinical Pharmacology
• Growth and Development

Background:

• Human immunodeficiency virus type 1 (HIV-1) infection impacts child development.
• Antiretroviral treatment (ART) is crucial for managing HIV-1.
• Protease inhibitors (PIs) are a key component of ART regimens.

Purpose of the Study:

• To assess the long-term effects of ART, specifically including protease inhibitors, on the growth of HIV-1-infected children.
• To evaluate growth patterns before and after the introduction of PIs in pediatric ART.

Main Methods:

• Prospective multi-center study in Switzerland.
• Inclusion of HIV-1-infected children receiving ART with ritonavir or nelfinavir plus nucleoside reverse transcriptase inhibitors.
• Measurement of child length/height at multiple time points before and after PI initiation.
• Expression of growth in standard deviations from the mean for age- and gender-independent comparison.

Main Results:

• A total of 44 children had complete data after 72 weeks of PI treatment.
• Growth declined by -0.3 SD before PI initiation.
• Significant catch-up growth was observed after PI introduction, particularly between weeks 0-24 (+0.33 SD) and 48-72 (+0.21 SD).
• Catch-up growth was primarily seen in previously stunted children and was more pronounced in those younger than 3 years.

Conclusions:

• Addition of protease inhibitors to ART promotes catch-up growth in HIV-1-infected children.
• The positive impact on growth is most notable in children under three years of age.
• This suggests PIs play a vital role in mitigating growth deficits associated with pediatric HIV-1.