Prevalence of Stunting, Wasting, and Overweight in HIV-Infected Thai Children Receiving Antiretroviral Therapy

Abstract

This study was carried out to assess stunted growth, wasting, underweight, and overweight in children living with HIV and determine the relationship between antiretroviral therapy, potential risk factors, and abnormal statuses (i.e., stunting, wasting, underweight, and overweight) in HIV-infected children. The sample was 110 HIV-infected children from Queen Sirikit National Institute of Child Health in Thailand. These 110 children had received antiretroviral therapy for at least five years. The median (interquartile range, IQR) duration of treatment follow-up was 10.1 years (IQR: 7.9 to 12.3), and 56.4% of these HIV-infected children were female. The median age at antiretroviral therapy initiation was 4.3 years (IQR: 1.5 to 8.6). One child had started therapy with dual nucleoside reverse transcriptase inhibitor-based antiretroviral therapy (dual NRTI-based), 51.8% of HIV-infected children had started on nevirapine-based antiretroviral therapy and 34.6% of HIV-infected children had started on efavirenz-based antiretroviral therapy. Of the 110 children, 35 (31.8%) were in category C according to the Centers for Disease Control and Prevention (CDC) classification of HIV infection at treatment initiation. At baseline, 39.2% were underweight, 17.7% had wasting, 49.0% were stunted, and 1.3% were overweight. After treatment at 1-year follow-up, the percentage of underweight, wasting, and stunting decreased to 15.7%, 4.6%, and 39.7% respectively, whereas overweight increased to 17.4%. Undernutrition 5-years after treatment continuously decreased; the percentage of underweight and stunting were 6.9% and 10.3%, respectively. After adjusting for sex, the multiple logistic regression models with repeated measurements suggested that HIV-infected children who received stavudine or efavirenz had a higher risk of stunting (adjusted odds ratio [aOR] = 6.13; p < 0.001 and aOR = 4.32; p = 0.012, respectively), and HIV-infected children with CD4 cell count <350 cells/m³ at baseline (aOR = 10.55; p = 0.001). Increased age at antiretroviral therapy initiation was associated with underweight (aOR = 1.23; p = 0.012), and children’s odds of being underweight significantly increased with stavudine use (aOR = 5.87; p < 0.001). Increased age at antiretroviral therapy initiation was associated with underweight (aOR = 1.23; p = 0.012), and children’s odds of being underweight were significantly increased in HIV-infected children who received stavudine-containing regimens (aOR = 5.87; p < 0.001). In addition, male children, stavudine use, and HIV-infected children with category B or C CDC classification of HIV infection were associated with a higher risk of wasting (aOR = 4.15; p = 0.005, aOR =2.66; p =0.044, and aOR =5.68; p = 0.025, respectively). After adjusting for sex and CDC classification, HIV-infected children who received stavudine-containing regimens had a higher risk of being overweight (aOR = 3.86; p = 0.035). In conclusion, anthropometric measurements including underweight, wasting, stunting, and overweight in HIV-infected children should be closely monitored, especially HIV-infected children receiving antiretroviral therapy containing stavudine or efavirenz.  Starting antiretroviral therapy at an early age and high CD4 cell counts were associated with reduced risk of underweight, wasting, and stunting in HIV-infected children. Thus, an increase in public relation channels for HIV-infected children to access antiretroviral therapy may help to slow down and prevent malnutrition in HIV-infected children.