Effects of combination antiretroviral therapy and nutritional rehabilitation on growth in children aged 6-36 months with severe acute malnutrition in IMPAACT protocol P1092.

ABSTRACT

BACKGROUND: Antiretroviral therapy (ART) is known to improve child survival and growth in children living with HIV (CLHIV). We investigated growth outcomes in children with severe non-edematous acute malnutrition (SAM) and without-SAM (mild malnutrition and normal nutrition) after initiation of ART in both groups and nutritional support. MATERIAL AND METHODS: IMPAACT P1092 enrolled CLHIV aged 6 to <36 months with WHO-defined SAM or without-SAM across 5 sites in Sub-Saharan Africa and followed them for 48 weeks. The enrollment was conducted in 4 countries Malawi, Tanzania, Uganda, and Zimbabwe. Weight, height, and mid-upper-arm circumference (MUAC) were measured at baseline through 48 weeks. WHO weight-for-length/height Z-scores (WFL/H Z-score) were calculated. SAM children received readily available therapeutic food per WHO guidelines. All participants were initiated on a triple-ART regimen. SAM children entered the study after initial nutritional rehabilitation. RESULTS: Fifty-two CLHIV, 25 in the SAM cohort and 27 in the without-SAM cohort, were enrolled. WFL/HZ-scores and MUAC in the SAM cohort increased significantly at weeks 24 and 48 (WFL/HZ-scores mean change [95% CI] 2.34 [1.77, 2.91] and 2.73 [2.09, 3.37], both p< 0.001; MUAC mean change [95% CI] 2.63 [1.98, 3.28] and 3.53 [2.83, 4.24] cm, p<0.001). At Week 48, mean SAM height was 4cm shorter and mean weight 1kg lighter than without SAM (post hoc mean differences -4.11 (95% CI -8.60, 0.38) cm and -0.92 (95% CI -2.22, 0.39) kg). CONCLUSION: CHLHIV with SAM who undergo WHO nutritional rehabilitation can achieve significant growth and WFL/HZ score improvements but continued intensive anthropometric monitoring is needed as SAM will still be behind those without SAM.