Avaliação longitudinal do crescimento ponderoestatural de uma coorte de crianças infectadas pelo vírus da imunodeficiência humana em uso de terapia antirretroviral combinada

Abstract

Background: Growth failure is a common feature of Human Immunodeficiency virus (HIV) infection. There are few data on long-term effects of highly active antiretroviral therapy (HAART) on weight and height in infected children. Our objective was to assess the impact of HAART initiation on growth parameters of infected-children over time in Brazil cohort, and analyze possible factors associated with this effect.Methods: Retrospective, longitudinal study at a reference center for HIV/AIDS in Belo Horizonte, Brazil. We analyzed growth parameters, clinical data and laboratory results of HIV-infected children, between 1 month and 12 years of age. Measurements of height, weight, viral load, CD4 lymphocytes number, type of HAART regime (with or without protease inhibitor) and CDC (Centers for Disease Control) clinical and immunological category were retrieved from the Centers records. Selected patients were ARV naïve, initiated HAART from 2000 to 2006 and were followed-up for 96 weeks. Height and weight age-adjusted z scores were calculated at 0, 24, 48 and 96 weeks after initiation of HAART, using the NCHS reference curves for age. Viral responders were defined as those who either reached an undetectable viral load or had a > 1, 0 log reduction in baseline viral load at weeks 24 of treatment. Children in immunological category 3 who had an elevation on baseline CD4 lymphocytes percentage above 5% or those in immunologic category 1 or 2 who had an elevation or maintenance on baseline CD4 lymphocytes number at week 24 of treatment were immunologic responders. A paired t test was used to compare the changes in the values of the different factors analyzed over time. To compare means of z scores between 2 groups we used the Students test. The ANOVA test was used when more than 2 groups were compared. The weight-age and height-age z scores were also categorized as -2 vs >-2 (our endpoint). We evaluated possible risk factors associated with lower z scores. Pearsons 2 test was used for bivariate analysis of all categorical variables, and possible covariables were evaluated by further logistic regression using p value < 0,25 to keep a variable in the model. Statistical analysis was performed by SPSS version 12.0 software and EpiInfo version 6.04. Results: 144 patients were included, 52% female, with a baseline median log viral load of 5,2 (IQR25%-75%: 4,65,9 log) and a median baseline CD4+ T cell count of 619 cells/mm³ (IQR 25-75%: 326-1127 cells/mm3); 38,9% were clinical category C and 44% immunological stage 2. HAART with protease inhibitors was used for 64% of patients. In bivariate analysis,HAART led to an increase in mean weight and height scores from baseline to 96 week (p<0,05): there was a significative improvement in weight-age z score (waz) from -2,0 to -0,6 and in height-age z score (haz) from -1,7 to -0,8; virologic response was associated with higher increase in height and weight parameters at 48 week (p=0,02; p=0,001,respectively); younger children also were associated significantly with an increase in weight z score after 2 years of treatment; there was no evidence of differential height or weight changes over time correlated to immunologic response. In multivariate analysis, type of HAART regime (with protease inhibitor) showed a trend to a final height z score >-2 after 2 years of treatment (p=0,06; OR 3,9; 95% IC 0,9-16,5). Conclusions: HAART has a positive influence effect on the growth of HIV-infected children. This effect is sustained for at least 96 weeks and seems to be correlated with virologic response in the first year of therapy, but not with immunologic response