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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.

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



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


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.


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.


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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