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Human Immunodeficiency Virus...

PEDIATRICS Vol. 108 No. 4 October 2001, p. e72

ELECTRONIC ARTICLE:
Impact of Protease Inhibitor-Containing Combination Antiretroviral Therapies on Height and Weight Growth in HIV-Infected Children

Received Mar 21, 2001; accepted May 30, 2001.

Kate Buchacz*, Joseph S. CerviaDagger , Jane C. Lindsey*, Michael D. Hughes*, George R. Seage III*, Wayne M. Dankner§, parallel , James M. Oleske, Jack Moye#, and for the Pediatric AIDS Clinical Trials Group 219 Study Team

From the * Harvard School of Public Health, Boston, Massachusetts; Dagger  Long Island Jewish Medical Center, New Hyde Park, New York; § University of California San Diego, San Diego, California; parallel  Parexel International Corporation, Durham, North Carolina;  University of Medicine and Dentistry of New Jersey, Newark, New Jersey; and # National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland.

Objective.  To examine beneficial or detrimental effects of protease inhibitor (PI)-containing antiretroviral regimens on height and weight growth in children with human immunodeficiency virus (HIV) infection.

Methods.  A prospective cohort study was conducted of 906 HIV-infected children, from pediatric research clinics in the United States, who were between 3 months and 18 years of age and who had height and weight assessed in 1995 (before introduction of PIs in this population) and at least once more through 1999. Changes in age- and gender-adjusted height and weight growth associated with PI use were assessed.

Results.  Compared with a healthy reference population, children were more affected in height (mean z score: -0.90 [18th percentile]) than in weight (mean z score: -0.42 [34th percentile]) at baseline (1995). Two thirds of children received at least 1 PI during 1996 to 1999. In the multivariate mixed effects regression models adjusted for baseline log10 CD4 cell count, baseline age, gender, and race/ethnicity, the use of PIs was associated with per-year gains of 0.13 z scores in height and 0.05 z scores in weight relative to the expected growth with non-PI-containing regimens (eg, after 1 year of PI use, a representative 6-year-old boy in our study would be approximately 0.7 cm taller and 0.1 kg heavier than if he had not received PIs). No significant differential effects of PIs on height or weight growth according to specific agents or children's sociodemographic or clinical characteristics were found.

Conclusions.  Although the use of PI-containing regimens was not associated with growth retardation, it was associated with only small annual increments in height and weight growth in HIV-infected children.  Key words:  HIV-1, protease inhibitor, growth, children.




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