HIV-infected children are significantly shorter and lighter than the uninfected children of HIV-positive mothers according to a large European study published in the 1st January 2003 edition of the journal Pediatrics. This is the first large study to monitor the growth patterns of HIV-positive and uninfected children of HIV-positive mothers over a long period of time. Other key findings of the study include: uninfected children of HIV-positive mothers grow at a comparable rate to the children of healthy mothers, and that antiretroviral therapy boosts the growth of HIV-positive children.
The European Collaborative Study has been running since 1987, and by October 2001 had enrolled 1,587 children, 184 of whom were HIV-positive, at eleven centres in eight countries. Investigators looked at height and weight patterns in infected and uninfected children of HIV-positive mothers up to ten years of age and looked at factors including HIV-related illness and antiretroviral therapy to assess their significance.
Height and weight were measured at birth, three and six months, and at three monthly intervals until eighteen months of age and then every six months thereafter. Results were compared between infected and uninfected children and the results of uninfected children were also compared with 1990 British growth standards for children.
Investigators found that at birth, infected and uninfected children had comparable weight and height. However, within the first year differences emerged in the growth rates of infected and uninfected children. Between six and twelve months, uninfected children grew 1.6% and 6.2% faster than infected children in height and weight.
By age three and four these differences had increased to 10.7% and 10.8% respectively with an even more marked increase between eight and ten years of age, to a 16% difference in height and 44% difference in weight.
By age ten, uninfected children were on average 7.5 cm taller than their HIV-infected peers and 7 kg heavier. What’s more, the uninfected children had height and weight comparable to the children of HIV-negative mothers.
The successful use of prophylactic drugs to prevent vertical transmission did not seem to impact on the growth rate of uninfected children. The investigators also found that children who were ill because of HIV grew at the slowest rate, leading them to note “HIV infection affects growth, particularly in the presence of AIDS conditions.” Treatment with antiretroviral therapy improved both height and weight in HIV-positive children, the improvements being most marked in severely ill children. However, the data set was small.
In the discussion of their study, the investigators suggest that, given the marked differences in growth between infected and uninfected children by age ten, HIV-positive children are likely to reach sexual maturity later and this possibility should be the subject of further investigation. High HIV viral load may be a predictor of retarded growth, suggest the investigators, with HIV replication affecting the metabolism and stunting growth. In addition, illness caused by HIV is also likely to affect growth.
Although this study did find a relationship between improved growth and the use of antiretroviral therapy, the investigators note that the number of children treated with anti-HIV drugs in their study was small. They conclude, “additional research on large data sets relating to infected children on therapy will help to elucidate the relationship between combination therapy and improved growth, in particular regarding different regimens and the best timing of initiation of therapy for optimizing growth of infected children.
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Newell ML et al. Height, weight, and growth in children born to mothers with HIV-1 infection in Europe. Pediatrics 111: 52-60, 2003.