Background:  Growth failure is a common feature of children with human immunodeficiency virus type 1 (HIV-1) infection and is a sensitive indicator of disease progression. Whether stunting and undernutrition can be reversed by antiretroviral therapy (ART) is not well understood. We studied the effect of Highly Active Antiretroviral therapy (HAART) on the growth and immunologic parameters of HIV-infected children in comparison with those not initiated on HAART.

Methodology:  HIV-infected children from birth to 15 years of age referred to the clinics of Tuberculosis Research Centre at Chennai and Madurai from May 2004 to December 2007 were recruited after obtaining written informed consent from their parent or guardian. Clinical examination, anthropometric measurements and baseline investigations (hematology, CD4, CD8 counts) were done. Children eligible for antiretroviral treatment were started on a triple-drug regimen (Stavudine, Lamivudine, and Nevirapine) at government ART centers according to national guidelines. They were followed regularly and investigations repeated every 6 months. Data was entered into Epi Info and Z-scores for weight, height, and BMI computed. Statistical analysis was performed using SPSS, Version 11.0. Data are expressed as median and interquartile range (IQR), as well as proportions.

Results:  In this study, 253 HIV-infected children were enrolled of whom 114 were started on ART (males 52, females 62, median age 76 months). The prevalence of underweight (WAZ <-2), stunting (HAZ<-2) and wasting (WHZ<-2) among the HAART group was 81%, 52%, and 56% respectively and among the non-HAART group was 52%, 53% and 18% respectively. After 1 year of HAART, weight for age increased significantly from baseline (-2.84, -3.25, -2.21, median, IQR) to -2.18 (-2.80 to -1.72) .However HAZ did not increase proportionately; (Median, IQR -2.02 (-3.38 to -0.68)) to (Median -2.27, IQR -3.35 to -1.16), respectively. Children who were initiated on HAART at CD4 >15% had less severe stunting (Median -1.33, IQR, -2.89 to -1.33)) and underweight (Median -1.90, IQR, -2.42 to -1.13) after one year. All growth indices worsened in the group not started on ART.

Conclusions:  While HAART has a positive effect on the growth of HIV-infected children, stunting persisted, which suggested that it may not be reversible. Earlier initiation of HAART may prevent severe stunting. Chronic malnutrition is a common feature of pediatric HIV, both on and off HAART and needs to be managed concurrently.