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Determinantes clínicos y contextuales del fallo antropométrico de base y mejoras longitudinales tras comenzar el tratamiento antirretroviral entre niños Sudafricanos
Author(s) -
Chhagan Meera K.,
Kauchali Shuaib,
Van den Broeck Jan
Publication year - 2012
Publication title -
tropical medicine and international health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.056
H-Index - 114
eISSN - 1365-3156
pISSN - 1360-2276
DOI - 10.1111/j.1365-3156.2012.03026.x
Subject(s) - anthropometry , baseline (sea) , medicine , antiretroviral treatment , longitudinal study , human immunodeficiency virus (hiv) , demography , antiretroviral therapy , environmental health , viral load , family medicine , political science , sociology , pathology , law
Objectives To describe baseline nutritional anthropometry and its determinants in a cohort of children commencing HAART, and subsequent longitudinal anthropometric trajectories over 2 years. Methods Prospective observational study in a prepubertal cohort of children commencing HAART in Durban, South Africa. Results Among 151 children with a median baseline age of 61.3 months (IQR 29.6, 90.1), prevalence of stunting was 54% (95% CI 46, 62) and of underweight, 37% (95% CI 29, 45). There was high prevalence of preceding respiratory and diarrhoeal comorbidities, which were associated with poorer anthropometry. There were significant improvements in height, weight and mid‐upper‐arm circumference z ‐scores after initiation of HAART regardless of preceding comorbidities. Stunted children remained shorter on average after 24 months, but younger children had better catch‐up. Children who eventually died had persistently worse anthropometry. Children who were exposed to improved programs for prevention of mother‐to‐child transmission (PMTCT) were younger and had more severe growth impairments at baseline. Conclusion Anthropometric status of children on HAART is influenced by age, preceding comorbidities, and by programmatic factors. With improved PMTCT programs, infants who would previously have died in infancy are now surviving to commence HAART. Poor outcomes are preceded by persistent anthropometric failure on HAART reaffirming the need for growth velocity monitoring.