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J Int AIDS Soc. 2019 Nov;22(11):e25412. doi: 10.1002/jia2.25412.

Stunting and growth velocity of adolescents with perinatally acquired HIV: differential evolution for males and females. A multiregional analysis from the IeDEA global paediatric collaboration.

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Inserm U1027, Université Paul Sabatier Toulouse 3, Toulouse, France.
University of Cape Town, Centre for Infectious Disease Epidemiology and Research, Cape Town, South Africa.
Medical Informatics and Technology, Institute of Public Health, UMIT - University for Health Sciences, Medical Decision Making and Health Technology Assessment, Hall in Tirol, Austria.
Inserm U1219, Bordeaux Population Health Center, Université de Bordeaux, Bordeaux, France.
Sanglah Hospital, Bali, Indonesia.
The Kirby Institute, UNSW, Sydney, Australia.
Hopital Gabriel Touré, Bamako, Mali.
CIRBA, Abidjan, Côte d'Ivoire.
Harriet Shezi Children's Clinic, Chris Hani Baragwanath Academic Hospital, Soweto, South Africa.
Faculty of Health Scences, Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa.
Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.
Department of Child Health and Paediatrics, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya.
Ryan White Center for Pediatric Infectious Disease and Global Health, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA.
Vanderbilt University School of Medicine, Nashville, TN, USA.
Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA.



Stunting is a key issue for adolescents with perinatally acquired HIV (APH) that needs to be better understood. As part of the IeDEA multiregional consortium, we described growth evolution during adolescence for APH on antiretroviral therapy (ART).


We included data from sub-Saharan Africa, the Asia-Pacific, and the Caribbean, Central and South America regions collected between 2003 and 2016. Adolescents on ART, reporting perinatally acquired infection or entering HIV care before 10 years of age, with at least one height measurement between 10 and 16 years of age, and followed in care until at least 14 years of age were included. Characteristics at ART initiation and at 10 years of age were compared by sex. Correlates of growth defined by height-for-age z-scores (HAZ) between ages 10 and 19 years were studied separately for males and females, using linear mixed models.


Overall, 8737 APH were included, with 46% from Southern Africa. Median age at ART initiation was 8.1 years (interquartile range (IQR) 6.1 to 9.6), 50% were females, and 41% were stunted (HAZ<-2 SD) at ART initiation. Males and females did not differ by age and stunting at ART initiation, CD4 count over time or retention in care. At 10 years of age, 34% of males were stunted versus 39% of females (p < 0.001). Females had better subsequent growth, resulting in a higher prevalence of stunting for males compared to females by age 15 (48% vs. 25%) and 18 years (31% vs. 15%). In linear mixed models, older age at ART initiation and low CD4 count were associated with poor growth over time (p < 0.001). Those stunted at 10 years of age or at ART initiation had the greatest growth improvement during adolescence.


Prevalence of stunting is high among APH worldwide. Substantial sex-based differences in growth evolution during adolescence were observed in this global cohort, which were not explained by differences in age of access to HIV care, degree of immunosuppression or region. Other factors influencing growth differences in APH, such as differences in pubertal development, should be better documented, to guide further research and inform interventions to optimize growth and health outcomes among APH.


HIV; adolescent; cohort studies; developing countries; growth; stunting

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