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Home >> Publications >> Antiretroviral Therapy in Severely Malnourished, HIV-infected Children in Asia.

Publication

Author(s):

Boettiger DC1, Aurpibul L, Hudaya DM, Fong SM, Lumbiganon P, Saphonn V, Truong KH, Hansudewechakul R, Nguyen LV, Do VC, Bunupuradah T, Chokephaibulkit K, Nik Yusoff NK, Kumarasamy N, Wati DK, Razali KA, Kariminia A; TREAT Asia Pediatric HIV Observational Database.

Pub Title:

Antiretroviral Therapy in Severely Malnourished, HIV-infected Children in Asia.

Pub Date:

May 1 2016

Pub Region(s):

Asia-Pacific

Journal:

Title: 
Pediatr Infect Dis J

PubMed: 26835972
Pub PDF:

BACKGROUND: Information on antiretroviral therapy (ART) use in HIV-infected children with severe malnutrition (SM) is lacking. We investigated long-term ART outcomes in this population.

METHODS: Children enrolled in the TREAT Asia Pediatric HIV Observational Database who had SM (weight-for-height or body mass index-for-age Z score less than -3) at ART initiation were analyzed. Generalized estimating equations were used to investigate poor weight recovery (weight-for-age Z score less than -3) and poor CD4% recovery (CD4% <25), and competing risk regression was used to analyze mortality and toxicity-associated treatment modification.

RESULTS: Three hundred fifty-five (11.9%) of 2993 children starting ART had SM. Their median weight-for-age Z score increased from -5.6 at ART initiation to -2.3 after 36 months. Not using trimethoprim-sulfamethoxazole prophylaxis at baseline was associated with poor weight recovery [odds ratio: 2.49 vs. using; 95% confidence interval (CI): 1.66-3.74; P < 0.001]. Median CD4% increased from 3.0 at ART initiation to 27.2 after 36 months, and 56 (15.3%) children died during follow-up. More profound SM was associated with poor CD4% recovery (odds ratio: 1.78 for Z score less than -4.5 vs. -3.5 to less than -3.0; 95% CI: 1.08-2.92; P = 0.023) and mortality (hazard ratio: 2.57 for Z score less than -4.5 vs. -3.5 to less than -3.0; 95% CI: 1.24-5.33; P = 0.011). Twenty-two toxicity-associated ART modifications occurred at a rate of 2.4 per 100 patient-years, and rates did not differ by malnutrition severity.

CONCLUSION: Trimethoprim-sulfamethoxazole prophylaxis is important for the recovery of weight-for-age in severely malnourished children starting ART. The extent of SM does not impede weight-for-age recovery or antiretroviral tolerability, but CD4% response is compromised in children with a very low weight-for-height/body mass index-for-age Z score, which may contribute to their high rate of mortality.

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Citation:

Pediatr Infect Dis J. 2016 May;35(5):e144-51. doi: 10.1097/INF.0000000000001074. Antiretroviral Therapy in Severely Malnourished, HIV-infected Children in Asia. Boettiger DC1, Aurpibul L, Hudaya DM, Fong SM, Lumbiganon P, Saphonn V, Truong KH, Hansudewechakul R, Nguyen LV, Do VC, Bunupuradah T, Chokephaibulkit K, Nik Yusoff NK, Kumarasamy N, Wati DK, Razali KA, Kariminia A; TREAT Asia Pediatric HIV Observational Database.