Antiretroviral Therapy in Severely Malnourished, HIV-infected Children in Asia

• Main Authors: David C. Boettiger, Linda Aurpibul, Dina Mukiarti Hudaya, Siew M. Fong, Pagakrong Lumbiganon, Vonthanak Saphonn, Khanh H. Truong, Rawiwan Hansudewechakul, Lam V. Nguyen, Viet C. Do, Torsak Bunupuradah, Kulkanya Chokephaibulkit, Nik Khairulddin Nik Yusoff, Nagalingeswaran Kumarasamy, Dewi Kumara Wati, Kamarul Azahar Razali, Azar Kariminia, C. V. Mean, S. Sarun, J. Tucker, F. J. Zhang, S. Saghayam, E. Chandrasekaran, L. P.P. Atmikasari, I. Y. Malino, N. Kurniati, D. Muktiarti, S. M. Fong, M. Thien, M. Lim, F. Daut, P. Mohamad, T. J. Mohamed, N. F. Abdul Rahman, N. A.D.R. Mohammed, R. Nallusamy, K. C. Chan, T. Sudjaritruk, V. Sirisanthana, P. Oberdorfer, S. Denjanta, W. Srisuk, A. Kongphonoi, P. Kosalaraksa, P. Tharnprisan, T. Udomphanit, G. Jourdain, T. Puthanakit, W. Prasitsuebsai, W. Chanthaweethip, K. Lapphra, W. Phongsamart, S. Sricharoenchai, Q. T. Du, C. H. Nguyen, T. M. Ha, V. T. An, K. D.T. Khu, A. N. Pham, L. T. Nguyen, O. N. Le, A. H. Sohn, N. Durier, C. Sethaputra, D. A. Cooper, M. G. Law, A. Kariminia
• Format: Journal
• Published: 2018
• Subjects: Medicine
• Online Access: https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=84964836173&origin=inward; http://cmuir.cmu.ac.th/jspui/handle/6653943832/56159
• Institution: Chiang Mai University

© Copyright 2016 Wolters Kluwer Health, Inc. All rights reserved. Background: Information on antiretroviral therapy (ART) use in HIV-infected children with severe malnutrition (SM) is lacking. We investigated long-term ART outcomes in this population. Methods: Children enrolled in the TREAT Asia Pediatric HIV Observational Database who had SM (weight-for-height or body mass index-for-age Z score less than -3) at ART initiation were analyzed. Generalized estimating equations were used to investigate poor weight recovery (weight-for-age Z score less than -3) and poor CD4% recovery (CD4% <25), and competing risk regression was used to analyze mortality and toxicity-associated treatment modification. Results: Three hundred fifty-five (11.9%) of 2993 children starting ART had SM. Their median weight-for-age Z score increased from -5.6 at ART initiation to -2.3 after 36 months. Not using trimethoprim-sulfamethoxazole prophylaxis at baseline was associated with poor weight recovery [odds ratio: 2.49 vs. using; 95% confidence interval (CI): 1.66-3.74; P < 0.001]. Median CD4% increased from 3.0 at ART initiation to 27.2 after 36 months, and 56 (15.3%) children died during follow-up. More profound SM was associated with poor CD4% recovery (odds ratio: 1.78 for Z score less than -4.5 vs. -3.5 to less than -3.0; 95% CI: 1.08-2.92; P = 0.023) and mortality (hazard ratio: 2.57 for Z score less than -4.5 vs. -3.5 to less than -3.0; 95% CI: 1.24-5.33; P = 0.011). Twenty-two toxicity-associated ART modifications occurred at a rate of 2.4 per 100 patient-years, and rates did not differ by malnutrition severity. Conclusion: Trimethoprim-sulfamethoxazole prophylaxis is important for the recovery of weight-for-age in severely malnourished children starting ART. The extent of SM does not impede weight-for-age recovery or antiretroviral tolerability, but CD4% response is compromised in children with a very low weight-for-height/body mass index-for-age Z score, which may contribute to their high rate of mortality.