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Growth in Human Immunodeficiency Virus–Infected Children Receiving Ritonavir-Containing Antiretroviral Therapy
Sharon A. Nachman, MD;
Jane C. Lindsey, ScD;
Stephen Pelton, MD;
Lynne Mofenson, MD;
Kenneth McIntosh, MD;
Andrew Wiznia, MD;
Kenneth Stanley, PhD;
Ram Yogev, MD
Arch Pediatr Adolesc Med. 2002;156:497-503.
Background Human immunodeficiency virus (HIV)–infected children often suffer
from impaired growth. Highly active antiretroviral therapy (HAART) successfully
reduces HIV 1 (HIV-1) RNA to 400 copies/mL or less in many children.
Objectives To determine if age- and sex-adjusted growth z
scores correlate with HIV-1 RNA level and if control of viral load for 48
and 96 weeks results in improved growth in children receiving highly active
antiretroviral therapy.
Design Secondary analysis of the cohort of children receiving ritonavir nested
in a randomized, open-label, clinical trial.
Subjects and Methods The Pediatric AIDS Clinical Trials Group Protocol 338 enrolled clinically
stable, antiretroviral therapy–experienced, HIV-infected subjects aged
2 through 17 years. Using data from subjects randomized to ritonavir-containing
regimens (n = 197), the association of growth z scores
and HIV-1 RNA levels were examined.
Main Outcome Measures Age- and sex-adjusted weight and height z scores.
Results Enrollment weights were comparable with age- and sex-adjusted norms,
but subjects receiving ritonavir-containing antiretroviral therapy were significantly
shorter (mean z score, -0.57 [29th percentile];
95% confidence interval, -0.73 to -0.40). Higher HIV-1 RNA levels
correlated with lower growth z scores (P<.01). Subjects achieving and maintaining HIV-1 RNA of 400 copies/mL
or less through 48 and 96 weeks experienced worse growth than subjects with
a less controlled viral load.
Conclusions In this pediatric cohort, a significant decline in height and weight z scores was found despite control of viral replication.
Further studies of growth are necessary to assess if nutritional and hormonal
adjuvants to highly active antiretroviral therapy should be considered to
improve growth in HIV-infected children.
From the Department of Pediatrics, State University of New York Health
Science Center at Stony Brook (Dr Nachman); Center for Biostatistics in AIDS
Research, Harvard School of Public Health, Boston, Mass (Drs Lindsey and Stanley);
Department of Pediatrics, Boston Medical Center (Dr Pelton); Pediatric, Adolescent
and Maternal AIDS Branch, National Institute of Child Health and Human Development,
National Institutes of Health, Rockville, Md (Dr Mofenson); Department of
Pediatrics, Children's Hospital, Boston (Dr McIntosh); Department of Pediatrics,
Jacobi Hospital, Einstein Medical Center, Bronx, NY (Dr Wiznia); and the Department
of Pediatrics, Children's Memorial Hospital, Northwestern University, Chicago,
Ill (Dr Yogev).
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ABSTRACT
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