2 research outputs found
Treatment with highly active antiretroviral therapy in human immunodeficiency virus type 1-infected children is associated with a sustained effect on growth
INTRODUCTION: Growth failure is a common feature of children with human
immunodeficiency virus type 1 (HIV-1) infection. Children who are treated
with mono or dual nucleoside analogue reverse transcriptase inhibitor
(NRTI) therapy show a temporary increase in weight gain and linear growth
rate. In adults, protease-inhibitor-containing antiretroviral therapy is
associated with a sustained weight gain and increased body mass index
(BMI). Experience with protease inhibitors and growth in children is still
limited. The data mainly deal with short-term effects on growth.
OBJECTIVE: To evaluate the effect of highly active antiretroviral therapy
(HAART) on growth in children with HIV-1 infection. DESIGN AND METHODS: We
analyzed selected growth parameters, clinical data, and laboratory results
as part of a prospective, open, uncontrolled, multicenter study to
evaluate the clinical, immunologic, and virologic response to HAART
consisting of indinavir, zidovudine, and lamivudine in children with HIV-1
infection. Height and weight were measured at 0, 12, 24, 36, 48, 60, 72,
84, and 96 weeks after initiation of HAART. Information about the
children's growth before enrollment in the study was retrieved from the
hospital medical records and/or the school doctor or health center. BMI
was calculated. z Scores were used to express the standard deviation (SD)
in SD units from the Dutch reference curves for age and gender. Viral
loads and CD4+ T-cell counts were examined prospectively and related to
these growth parameters. z Scores were also calculated for CD4+ T-cell
counts to correct for age-related differences. A z score of 0 represents
the P50, which is exactly the age/sex-appropriate median. A height z score
of -1 indicates that a child's height is 1 SD below the age- and
gender-specific median height for the normal population. Virologic
responders were defined as those who either reached an undetectable viral
load (1.5 log reduction in viral load compared
with baseline at week 12 after the initiation of HAART, which was
maintained during the follow-up period. RESULTS. PATIENTS: Twenty-four
patients were included (age: 0.4-16.3 years at baseline), with a median
HIV-1 RNA load of 105 925 copies/mL (5.03 log), a median CD4+ T-cell count
of 0.586 x 10(9)/L (median z score: -2.28 SD), a median height z score of
-1.22, a median weight z score of -0.74, and a median baseline BMI z score
of -0.32. Eleven patients were naive to antiretroviral therapy, and 13
patients had received previous treatment with NRTI monotherapy. Twenty
children used indinavir and 4 children used nelfinavir as part of HAART.
VIROLOGIC AND IMMUNOLOGIC RESPONSES TO HAART: Seventeen children were
virologic responders, and 7 children were virologic nonresponders. In
patients naive to NRTIs, median baseline viral loads were significantly
higher than in pretreated patients. However, at weeks 48 and 96, there was
no significant difference between the viral loads of both groups. At
baseline, there was no significant difference in CD4+a T-cell z scores
between virologic responders and nonresponders or between naive and
pretreated patients. During 96 weeks of HAART, the increase of CD4+ T-cell
z score was significantly higher in responders than in nonresponders. The
increase in CD4+ T-cell z score was not significantly different for naive
and pretreated patients. HEIGHT, WEIGHT, AND BMI z SCORE CHANGES: We found
that
Plasma lipid profiles discriminate bacterial from viral infection in febrile children
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