ABSTRACT
A cross-sectional study of 358 HIV-1-infected children and adolescents living in Sub-Saharan Africa treated with tenofovir disoproxil fumarate-based regimens for a median of 1.5 interquartile range [0.6-3.1 years] showed a loss of glomerular filtration rate estimated to be 0.41 mL/min/1.73 m per month of treatment. In contrast, there was no decrease depending on the duration of the previous antiretroviral treatment.
Subject(s)
Anti-HIV Agents/adverse effects , Anti-HIV Agents/therapeutic use , Glomerular Filtration Rate/drug effects , Tenofovir/adverse effects , Tenofovir/therapeutic use , Adolescent , Africa South of the Sahara , Africa, Central , Child , Child, Preschool , Cross-Sectional Studies , Female , HIV-1/drug effects , Humans , MaleABSTRACT
BACKGROUND: We assessed a nutritional support intervention in malnourished HIV-infected children in a HIV-care program of the University Hospital Gabriel Touré, Bamako, Mali. METHODS: All HIV-infected children younger than 15 years were diagnosed for malnutrition between 07 and 12, 2014. Malnutrition was defined according to the WHO growth standards with Z-scores. Two types were studied: acute malnutrition (AM) and chronic malnutrition (CM). All participants were enrolled in a 6-month prospective interventional cohort, receiving Ready-To-Use Therapeutic Food, according to type of malnutrition. The nutritional intervention was offered until child growth reached -1.5 SD threshold. Six-month probability to catch up growth (>-2 SD) was assessed for AM using Kaplan-Meier curves and Cox model. RESULTS: Among the 348 children screened, 198 (57%) were malnourished of whom 158 (80%) children were included: 97 (61%) for AM (35 with associated CM) and 61 (39%) with CM. Fifty-nine percent were boys, 97% were on antiretroviral therapy, median age was 9.5 years (Interquartile Range: 6.7-12.3). Among children with AM, 74% catch-up their growth at 6-month; probability to catch-up growth was greater for those without associated CM (adjusted Hazard Ratio = 1.97, CI 95%: 1.13 to 3.44). Anemia decreased significantly from 40% to 12% at the end of intervention (P < 0.001). CONCLUSIONS: This macronutrient intervention showed 6-month benefits for weight gain and reduced anemia among these children mainly on antiretroviral therapy for years and aged greater than 5 years at inclusion. Associated CM slows down AM recovery and needs longer support. Integration of nutritional screening and care in the pediatric HIV-care package is needed to optimize growth and prevent metabolic disorders.
