Lazarus E 1 ; Otwombe K 1 ; Mohapi L 1 ; Cescon A 2,3 ; Violari A 1 ; Laher F 1

1. Effect of baseline immunological condition, virological response and duration of HAART on growth in HIV-infected adolescents. Lazarus E1; Otwombe K1; Mohapi L1; Cescon A2,3; Violari A1; Laher F1 Institutions:1Perinatal HIV Research Unit, Soweto, South Africa, 2Simon Fraser University, Faculty of Health Sciences, Burnaby, Canada, 3British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada,

2. HIV is associated with poor growth in children1-3 Stunting (short-for-age) is the most common abnormal growth pattern4 Height-for-age is more closely linked to disease progression than weight-for age5 Survival related to height growth velocity6 1Gertner JM , J Pediatr 1994; 2Moye J Jr, J Pediatr 1996; 3Carey VJ, AIDS 1998; 4Arpadi, JAIDS 2000; 5Benjamin DK, AIDS 2003; 6Chantry CJ, Pediatr Infect Dis J, 2003 Effect of HIV on child & adolescent growthfrom the literature Background Methods Results Conclusions

3. Effect of HAART on child & adolescent growthfrom the literature Background Methods Results Conclusions • HAART improves weight and height1-8 • Improved growth may be associated with • Virological response1,5 • Immunological response3,6 • Immunological stage at initiation of ART8 • Age at start of HAART3,7,8 1Guillén S, Pediatr Infect Dis J 2007; 2Kabue MM, AIDS Patient CARE STDS 2008; 3 Nachman SA, Pediatr Infect Dis J 2005; 4Song R, Pediatrics 2007; 5Verweel G, Pediatrics 2002; 6Ghaffari G, Pediatrics 2004; 7Bakeera-Kitaka S, J Pediatr Infect Dis, 2008; 8Kekitiinwa A, JAIDS,2008

4. Aim Background Methods Results Conclusions • To determine the correlation with adolescent growth of: • baseline CD4 • age at initiation of HAART • virological response • treatment duration

5. Setting Background Methods Results Conclusions Retrospective, cross-sectional analysis Perinatal HIV Research Unit, Soweto, S Africa HAART-recipients aged 11-19 years

6. How is growth measured? Wt & ht plotted on centile chart Z-score calculated using SAS software provided by the CDC Z-score: measure of standard deviations from mean 50th centile z-score = 0 Example 13 year old female Wt = 35kg WAZ = -2.48 Ht = 140 cm HAZ = -1.57 Background Methods Results Conclusions

7. What is growth? Background Methods Results Conclusions • Difference between gender adjusted growth measurements between most recent clinic visit and baseline: • Weight for age z-score (WAZ) • Height for age z –score (HAZ)

8. Statistical analysis Background Methods Results Conclusions • Chi-square contingency table analysis: association between growth and • duration of treatment • baseline CD4 • age at baseline • most recent viral load. • Where an association existed, a univariate analysis was performed to determine the predictor of growth. • 5% significance level

9. Background characteristics Background Methods Results Conclusions

10. Growth Background Methods Results Conclusions

11. Growth Background Methods Results Conclusions

12. Growth Background Methods Results Conclusions

13. Results Background Methods Results Conclusions

14. Conclusion Background Methods Results Conclusions • Higher baseline CD4 count predicts better growth in height • To optimise growth outcomes into adolescence, we recommend HAART initiation at baseline CD4 count >200 cells/ml for children >5 years old

15. START early GROW better 15

16. Limitations Background Methods Results Conclusions • Retrospective • Non-randomised

17. Acknowledgments Background Methods Results Conclusions • Clinicstaff of adult & paediatric clinics • Doctors Haseena Cassim, Xolile Dlamini, Mfundo Kuhlase, Afaaf Liberty, Mpolokeng Melamu, Geraldinah Mjali, Ashaan Naidoo, Faeezah Patel • Sisters Noreen Boikanyo, Jackie Brown, Sizakele Ncongwane, Rebecca Phofa • Nurses Gloria Tshabalala, Mpho Kokoele, Cathy Lephoto, Mitha Madiba, Patricia Masiya, Busi Saba • USAID for providing funding to care for these adolescents. • Our adolescent patients and their caregivers