Height and timing of growth spurt during puberty in young people living with vertically acquired HIV in Europe and Thailand

OBJECTIVE: To describe growth during puberty in young people with vertically acquired HIV. DESIGN: Pooled data from 12 paediatric HIV cohorts in Europe and Thailand. METHODS: 1094 children initiating an NNRTI- or boosted PI-based regimen aged 1 to 10 years were included. Super Imposition by Translation And Rotation (SITAR) models described growth from age 8 years using 3 parameters (average height, timing and shape of the growth spurt), dependent on age and height-for-age z-score (HAZ) (World Health Organisation references) at ART initiation. Multivariate regression explored characteristics associated with these 3 parameters. RESULTS: At ART initiation median age and HAZ was 6.4[IQR:2.8,9.0] years and -1.2[-2.3,-0.2], respectively. Median follow-up was 9.1[6.9,11.4] years. In females, older age and lower HAZ at ART initiation were independently associated with a growth spurt which occurred 0.41 (95% CI 0.20,0.62) years later in children starting ART age 6-<11 years compared to 1-<3 years and 1.50 (1.21,1.78) years later in those starting with HAZ<-3 compared to HAZ≥-1. Later growth spurts in females resulted in continued height growth into later adolescence. In males starting ART with HAZ<-1, growth spurts were later in children starting ART in the oldest age group, but for HAZ≥-1 there was no association with age. Males and females who initiated ART with HAZ≥-1 maintained a similar height to the WHO reference mean. CONCLUSIONS: Stunting at ART initiation was associated with later growth spurts in females. Children with HAZ≥-1 at ART initiation grew in height at the level expected in HIV negative children of a comparable age