Antiretroviral therapy for HIV-1 infected adolescents in Uganda: Assessing the impact on growth and sexual maturation
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Date
2008
Journal Title
Journal ISSN
Volume Title
Publisher
Journal of Pediatric Infectious Diseases
Abstract
Abstract. There is a paucity of knowledge about perinatally infected human immunodeficiency virus (HIV) positive children
surviving into their adolescent years, especially from sub-Saharan Africa. Although studies have described the effects of the
disease on the physical and sexual maturation of this population, their response to highly active antiretroviral therapy has not been systematically studied. At the pediatric infectious diseases clinic in Mulago hospital, Kampala, Uganda, we evaluated the effect of antiretroviral therapy (ART) on 118 treatment-naive, perinatally-infected HIV positive adolescents between the ages of 10–19 for 12 months. We monitored physical growth using The Centers for Disease Control and Prevention and recently published World Health Organization (WHO) reference growth standards for height and weight measurements as well as sexual maturation using Tanner staging. Laboratory tests including: complete blood count, absolute CD4 cell count and percentage, and HIV-1 RNA viral load, were performed at baseline and at 3-month intervals. Of 118 children, 64% were female; the median age was 13.6 years old. At baseline, 75% were classified as WHO clinical stages III and IV, with a median CD4 count of 124 cells/ul.
Apart from four adolescents, all were on first-line antiretroviral therapy with 2 nucleoside reverse transcriptase inhibitors and
1 non-nucleoside reverse transcriptase inhibitors. After 6 months, the median CD4 count was 304 cells/μL, increasing to 370
cells/μL, by 12 months. Antiretroviral therapy was virologically suppressive (HIV-1 RNA viral load <400 copies/mL) in 79%
of the adolescents at 6 months and in 89% at 12 months. Six (5%) patients died during the 12-month study. The median baseline
height for age Z score was −2.41 which improved to a median of −1.96 by 12 months (P < 0.0001). The median baseline
weight for age Z score was −2.61 and improved to −1.26 by 12 months (P < 0.0001). The median body mass index Z score
increased from −1.39 to −0.47 by 12 months (P < 0.0001). At baseline, 63% of the adolescents were noted to have delayed
pubertal maturation; this only reduced slightly to 60% after 12 months. Adolescents with predominantly perinatally-acquired
HIV infection and significant disease burden showed appropriate virologic and immunological response to ART in addition to
having clinically significant improvements in growth and some improvement in sexual maturation.
Description
Keywords
Adolescents, HIV, Africa, Antiretroviral therapy
Citation
Bakeera-Kitaka, S., McKellar, M., Snider, C., Kekitiinwa, A., Piloya, T., Musoke, P., ... & Colebunders, R. (2008). Antiretroviral therapy for HIV-1 infected adolescents in Uganda: assessing the impact on growth and sexual maturation. Journal of Pediatric Infectious Diseases, 3(02), 097-104.DOI: 10.1055/s-0035-1556974