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Growth, weight gain and BMI in virally suppressed children on antiretroviral therapy with specific reference to
Erik Belfrage1, Sandra Soeria-Atmadja1,2, Lars Navér3,4
1Department of Pediatrics, Karolinska University Hospital, Huddinge 14186, K76-78, Stockholm, Sweden.
Insights
Pediatric HIV patients on antiretroviral therapy (ART) showed improved height and weight. Dolutegravir-based ART did not appear to cause excessive weight gain in children and adolescents, though adolescent girls experienced significant weight gain.
Area of Science:
- Pediatric Endocrinology
- Infectious Diseases
- Clinical Pharmacology
Background:
- Pediatric HIV infection can impede growth, but effective antiretroviral therapy (ART) promotes weight gain.
- Concerns exist about excessive weight gain with dolutegravir in adults; data in pediatric populations are limited.
Purpose of the Study:
- To investigate the impact of dolutegravir-containing ART on body mass index (BMI) and height development in children and adolescents with HIV.
- To assess weight gain patterns in relation to ART regimens, including dolutegravir.
Main Methods:
- Retrospective cohort study of 94 children and adolescents living with HIV.
- Analysis of height, weight, and BMI standard deviation scores (SDS) in relation to ART, including switches to dolutegravir.
Main Results:
- Height SDS improved significantly, with most children falling within the normal range.
- Mean BMI SDS increased in girls but remained stable in boys.
- No significant association found between dolutegravir-based ART and excessive weight gain; adolescent girls showed weight gain independent of ART.
Conclusions:
- Height development in pediatric HIV patients on ART is generally within normal ranges.
- Dolutegravir-containing ART was not associated with excessive weight gain in this cohort.
- Adolescent girls experienced notable weight gain, warranting further investigation.
Background:
Pediatric HIV infection cause retardation in height and weight. However, effective antiretroviral therapy (ART) result in desirable weight gain. Concerns have emerged regarding excessive weight gain related to the integrase inhibitor dolutegravir in adults but knowledge about the circumstances in children/adolescents is limited. We studied if dolutegravir containing ART or switch to dolutegravir affected body mass index (BMI) and described height development in the Stockholm pediatric/adolescent HIV cohort.
Methods:
A retrospective cohort study of height, weight and BMI in relation to ART in 94 children/adolescents living with HIV.
Results:
At last documented visit 60/94 children/adolescents were on dolutegravir, 50 had switched from a protease inhibitor or non-nucleoside reverse transcriptase inhibitor. Height standard deviation score (SDS) increased between first and last visit from mean height SDS -0.88 (16 had SDS < -2 and 6 SDS < -3) to -0.32 (four had SDS < -2). Mean BMI SDS increased from -0.15 to 0.62 in girls, but not (-0.20 to 0.09) in boys. The number of girls ≥ 12 years with BMI SDS ≥ 2 increased significantly from 0/38 to 8/38 and totally 9/50 (18%) girls and 4/44 (9%) boys had BMI SDS ≥ 2 at last visit. There was no difference in height or weight gain between different ART regimens. BMI SDS remained stable in 22/50 children switching to dolutegravir, decreased in 13 and increased in 15.
Conclusion:
Adolescent girls gained weight to a greater extent than expected but independently of ART. We found no association between dolutegravir alone or combined with tenofovir alafenamide fumarate (TAF) and excessive weight gain. Height development was within normal range.
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