August 16, 2006 (AIDSmeds)—New data reported at the XVI International AIDS
Conference (IAC) in Toronto indicates that HIV treatment dramatically
improves growth and body composition in HIV-positive children.
In fact, the AIDS Clinical Trials Group study concludes that
HIV-positive children starting or switching HIV treatment actually have
higher gains in weight, height, and lean body mass than HIV-uninfected
children.
Numerous studies have demonstrated that
HIV-positive children suffer from poor growth and body composition
(water, fat, and muscle), which has been shown to be associated with
more rapid disease progression. While the exact cause, or causes, of
poor growth in these children has not been fully determined, data
collected over the past ten years suggests that HIV treatment can lead
to improvements in growth and body composition.
Pediatric
AIDS Clinical Trials Group study 1010, reported during an IAC session
on Monday by Caroline Chantry, MD, of the University of California
Davis Medical Center, was conducted to evaluate changes in growth in
children starting or changing HIV treatment. It was a 48-week clinical
trial that enrolled HIV-positive children between one month and 13
years of age. All children were either starting treatment or switching
to a protease inhibitor-based regimen for the first time.
Ninety-seven
pediatric patients were enrolled. Nine percent were infants, 15% were
toddlers, 34% were between three and eight years of age, and 41% were
between eight and 13 years of age. The average viral load upon entering the study was approximately 50,000 and the average CD4 cell percentage
(T cell percentage) – considered to be a more accurate measure of CD4
cell function in children – was 25%. Twenty-nine percent of the
children were starting treatment for the first time and 24% were
switching to a protease inhibitor-based regimen for the first time.
The
HIV-positive children were compared to a large cohort of 6,819
HIV-negative children participating in the National Health and
Nutrition Examination Survey (NHANES).
After 48 weeks
of treatment, which was chosen for each patient by the study
researchers, 54% of the children had viral loads below 50. There were
also significant increases in weight and height, along with a
significant increase in fat-free mass, a good indicator of improved
body composition.
Additional analysis of the study
data demonstrated that the status of the children at study entry – not
the viral load and CD4 count responses to therapy, nor the HIV
treatments used during the study – was the best predictor of growth and
body composition improvements. Lower body composition, CD4 cell
percentage, and age at study entry were predictive of the greatest
increases in weight. As for height, waist circumference, body fat
percentage, and body composition measurements of triceps skinfold
thickness and mid-arm muscle circumference, a lower body mass at
baseline was the most predictive value.
Finally,
compared to the children of similar ages in the NHANES cohort, the
HIV-positive children – after 48 weeks of treatment – had significantly
greater body weight, height, and fat-free mass. In other words, not
only does HIV treatment improve growth and body composition in
HIV-positive children, it actually boosts healthy growth and body
composition to above-normal levels. These data, the study authors
concluded, are encouraging.
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