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Growth and Metabolic Changes After Antiretroviral Initiation in South African Children

Michela Masi-Leone1, Stephen Arpadi2,3,4, Chloe Teasdale2,3

  • 1From the Master of Public Health Biostatistics Program, Icahn School of Medicine at Mount Sinai, New York, NY.

The Pediatric Infectious Disease Journal
|July 22, 2021
PubMed

Insights

High viral load in children living with HIV (CLHIV) starting antiretroviral therapy (ART) is linked to poor growth and metabolic issues. Early diagnosis and prompt ART initiation are crucial for better outcomes in CLHIV.

Area of Science:

  • Pediatric Infectious Diseases
  • HIV/AIDS Research
  • Metabolic Health in Children

Background:

  • Children living with HIV (CLHIV) often experience growth deficits and metabolic complications.
  • Antiretroviral therapy (ART) is critical for managing HIV in children, but its impact on growth and metabolism requires further investigation.
  • Understanding the role of viral load (VL) at ART initiation is key to optimizing treatment strategies.

Purpose of the Study:

  • To evaluate the impact of baseline viral load (VL) on growth parameters and lipid profiles in South African children initiating first-line antiretroviral therapy (ART).
  • To assess the association between VL and outcomes like length-for-age Z-score (LAZ), weight-for-age Z-score (WAZ), and lipid levels over time.
  • To identify the prevalence of metabolic risk factors, such as those for type 2 diabetes, at the time of ART initiation.

Main Methods:

  • Retrospective analysis of South African CLHIV under 12 years old initiating WHO-recommended first-line ART between 2012 and 2015.
  • Calculation of Z-scores for length-for-age (LAZ), weight-for-age (WAZ), and BMI-for-age.
  • Measurement of lipid profiles (total cholesterol, LDL, HDL) and Hemoglobin A1C to assess diabetes risk.
  • Application of mixed-effects models to determine the association of VL with growth and lipid outcomes over time.

Main Results:

  • In children <3 years initiating ART, higher VL was significantly associated with lower mean LAZ, WAZ, and LDL levels.
  • In children ≥3 years, higher VL correlated with lower LAZ and WAZ, and showed a trend towards significance for lower LAZ.
  • Higher VL was also linked to more rapid increases in LAZ and WAZ in the older age group (≥3 years).
  • A notable 30% of CLHIV were identified as being at risk for type 2 diabetes at ART initiation.

Conclusions:

  • Children initiating ART at <3 years showed improvements in growth and lipids, but high VL at baseline was linked to sustained poor outcomes.
  • These findings highlight the critical importance of early diagnosis and rapid initiation of ART for CLHIV.
  • Further research is needed to understand the long-term cardiometabolic consequences for CLHIV based on these early-life treatment dynamics.
Abstract

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