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Pediatr Infect Dis J. 2018 Aug;37(8):781-787. doi: 10.1097/INF.0000000000001932.

Malnutrition, Growth Response and Metabolic Changes Within the First 24 Months After ART Initiation in HIV-infected Children Treated Before the Age of 2 Years in West Africa.

Author information

1
From the Inserm U1219, University of Bordeaux, Institut de Santé Publique, d'Epidémiologie et Développement (ISPED), Bordeaux, France.
2
MONOD Project, ANRS 12206, Centre de Recherche Internationale pour la Santé, Ouagadougou, Centre Muraz, Bobo-Dioulasso, Burkina Faso.
3
Paediatric Department, Centre Hospitalier Universitaire of Cocody, Abidjan, Côte d'Ivoire.
4
Paediatric Department, Centre Hospitalier Universitaire Yalgado Ouédraogo, Burkina Faso.
5
Centre de Prise en charge de Recherche et de Formation (CePReF-enfants), Abidjan, Côte d'Ivoire.
6
Paediatric Department, Centre Hospitalier Universitaire Charles de Gaulle, Ouagadougou, Burkina Faso.
7
PACCI Programme, Site ANRS, Projet Monod, Abidjan, Côte d'Ivoire.
8
EA 8, Université-Paris Descartes, Immunology, Hematology, Rhumatologie Unit, Hopital Necker Enfants Malades-Assistance Publique Hopitaux de Paris, Paris, France.
9
Paediatric Department, Centre Hospitalier Universitaire de Yopougon, Abidjan, Côte d'Ivoire.
10
Inserm U1027, Université Paul Sabatier Toulouse 3, Toulouse, France.

Abstract

BACKGROUND:

There is limited information about malnutrition, growth evolution and metabolic changes among children initiated early on lopinavir-based antiretroviral therapy (ART) in Africa.

METHODS:

HIV-1-infected children, age <2 years were initiated on ART, as part of the MONOD ANRS 12206 project, conducted in Burkina Faso and Côte d'Ivoire. Weight-for-age, height-for-age and weight-for-height Z scores defined malnutrition [Z score less than -2 standard deviations (SDs)] using World Health Organization growth references. Biologic data were collected every 6 months. Factors associated with baseline malnutrition were evaluated using multivariate logistic regression, and with growth evolution in the first 24 months on ART using linear mixed models.

RESULTS:

Between 2011 and 2013, 161 children were enrolled: 64% were from Abidjan, 54% were girls. At ART initiation, median age was 13.7 months (interquartile range 7.7; 18.4), 52% were underweight (weight-for-age), 52% were stunted (height-for-age) and 36% were wasted (weight-for-height). Overall, baseline malnutrition was more likely for children living in Burkina Faso, with low birth weight, never breastfed and older age (12-24 months). Growth improved on ART, mainly within the first 6 months for weight, and was greater for the most severely malnourished children at baseline, but 8%-32% remained malnourished after 24 months. Over the 24-month period of ART, there was a significant increase of hypercholesterolemia and decrease of anemia and hypoalbuminemia.

CONCLUSIONS:

Prevalence of malnutrition was high before ART initiation. Even though growth improved on ART, some children remained malnourished even after 2 years of ART, highlighting the need for more active nutritional support.

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