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Dysregulation of growth and development in HIV-infected children
1Pediatric Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA.
Insights
Growth failure in children with human immunodeficiency virus (HIV) infection is common. Antiviral therapies improving viral load are linked to better growth, suggesting metabolic and endocrine factors are key.
Area of Science:
- Pediatric Endocrinology
- Infectious Diseases
- Human Immunodeficiency Virus (HIV) Research
Background:
- Growth dysregulation and failure are common in children with HIV, serving as sensitive indicators of disease progression.
- HIV-infected infants often exhibit smaller size and lower birth weight compared to their non-infected peers.
- Causes are multifactorial, including gastrointestinal dysfunction, recurrent infections, and metabolic/endocrine alterations.
Purpose of the Study:
- To explore the complex factors contributing to growth dysregulation in HIV-infected children.
- To investigate the relationship between viral burden, metabolic changes, and growth outcomes.
- To highlight the need for interventions beyond caloric supplementation.
Main Methods:
- Review of existing correlational studies examining viral burden and anthropometric indices.
- Analysis of metabolic, endocrine, and cytokine profile alterations in HIV-infected children.
- Assessment of the impact of antiviral therapy on growth parameters.
Main Results:
- An inverse relationship exists between viral burden and linear growth/body mass index.
- Antiviral medications reducing viral load correlate with improved growth indices.
- Pubertal delay, particularly in boys, is a frequent complication contributing to overall growth failure.
Conclusions:
- Metabolic and endocrine dysregulation, potentially influenced by HIV infection and its treatment, significantly impacts growth.
- Cellular-level abnormalities, indicated by cytokine profiles and hormonal axes, are implicated.
- Effective interventions for growth failure in HIV-infected children require addressing these underlying metabolic and regulatory issues, not just caloric intake.
Abstract:
Growth dysregulation is quite common in HIV-infected children and growth failure is one of the most sensitive indicators of disease progression. Beginning at birth, HIV-infected infants often have smaller size and lower birthweight than noninfected children born to HIV-infected women. The causes of growth dysregulation are varied, and can be due to alterations in gastrointestinal function, chronic or repetitive infections, and alterations in metabolic and endocrine function. The metabolic and endocrine effects may be the consequence of the primary infection or secondary to the use of any of the medications required to treat HIV infection and its complications. Correlational studies have identified an inverse relationship between viral burden and linear growth and body mass index, i.e., the use of antiviral medications that reduce viral burden is associated with improvements in anthropometric indices of growth. Alterations in cytokine profiles, possibly related to reported abnormalities in thyroid indices, fat metabolism, and the somatomedin axis, may be indicative of dysregulation on a cellular level. Pubertal delay, especially among boys, is common, and may contribute to the overall growth failure associated with HIV infection. If the basis for growth failure resides in metabolic and regulatory abnormalities, then interventions beyond increasing caloric intake will be necessary to increase linear growth rate and reverse growth failure in HIV-infected children.