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Growth velocity assessment in paediatric AIDS: smoothing, penalized quantile regression and the definition of growth

V J Carey1, F H Yong, L M Frenkel

  • 1Center for Biostatistics in AIDS Research, Harvard School of Public Health, 655 Huntington Avenue, Boston MA 02115, U.S.A. stvjc@channing.harvard.edu

Statistics in Medicine
|January 30, 2004
PubMed

Insights

This study develops a new criterion to identify growth failure in children with HIV/AIDS, aiding clinical trial evaluation and disease staging, especially where advanced monitoring is limited.

Area of Science:

  • Pediatric Infectious Diseases
  • Clinical Trial Methodology
  • Biostatistics

Background:

  • Growth failure is a critical indicator of disease progression or treatment toxicity in pediatric HIV/AIDS clinical trials.
  • Accurate monitoring of somatic growth is essential despite advances in HIV treatment, due to uncertainties in viral load reduction's impact on growth.
  • Existing methods may not adequately identify children at high risk of mortality following growth failure.

Purpose of the Study:

  • To develop a novel criterion for defining growth failure in pediatric HIV/AIDS patients.
  • To identify growth patterns indicative of a significantly elevated risk of death.
  • To create a tool for disease staging in resource-limited settings.

Main Methods:

  • Modeling individual growth curves and velocities using loess smoothing.
  • Fitting penalized likelihood quantile regressions to age-specific growth velocity distributions.
  • Utilizing proportional hazards model selection to identify survival-informative velocity features.

Main Results:

  • A criterion for growth failure was constructed based on modeled growth velocities.
  • The criterion effectively discriminates patients with elevated mortality risk subsequent to growth failure.
  • The developed method identifies key velocity features predictive of survival.

Conclusions:

  • The new growth-failure criterion is a valuable tool for assessing outcomes in pediatric anti-HIV clinical trials.
  • This criterion can aid in disease staging for pediatric AIDS patients, particularly in resource-limited environments.
  • The findings enhance the interpretation of growth data in the context of HIV/AIDS management.

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