Statural Growth in HIV-Infected Children

  • Edna S. Majaliwa
  • Paul Laigong
  • Nathan Tumwesigye
  • Francesco Chiarelli
Chapter

Abstract

Growth faltering in vertically HIV-infected children may be an early marker of infection or progression of disease. Pediatric HIV infection is associated with linear and ponderal growth retardation. Differing trajectories of infant and child growth are associated with different patterns of disease and mortality in adulthood. Studies conducted largely in industrialized countries have identified multiple primary and secondary factors involved in growth failure. It has been estimated that ∼50% of HIV-infected children experience abnormal growth patterns. Height velocity (height-for-age Z-score) is the growth index most closely associated with clinical progression, immune reconstitution and declines in viral replication among US children receiving potent antiretroviral therapies (ART). Height growth may also be an important predictor of survival regardless of HIV status. In these children the growth failure and pubertal delay may be the clinical features of endocrine dysfunction. Growth delay can be exacerbated by a variety of treatable infections, endocrine, nutritional, and immunological disorders. It is well known that growth impairment is a marker of advanced disease and requires proper evaluation. Timely diagnosis and appropriate treatment of these conditions may lead to improvement or even normalization of growth. Antiretroviral therapy which is a core treatment in HIV infection may be associated with endocrine dysfunction with consequences on growth. Growth retardation and pubertal delay are always seen in children with advanced infection and are often related to the pro-inflammatory milieu found in advanced AIDS. Therefore, HIV-infected children with advanced disease should undergo periodic growth evaluation, including growth hormone levels, IGF-1, IGFBP-3, and androgens, in order to identify subclinical endocrine dysfunction. Growth in HIV-infected children generally improves with ART. Pediatric care providers should implement appropriate preventive, screening, and therapeutic strategies to maximize survival and quality of life in these children.

Keywords

Zinc Toxicity Depression Carbohydrate Europe 

Abbreviations

ART

Antiretroviral therapies

ECS

European Collaboration Study

HAART

Highly active antiretroviral therapy

HIV

Human immunodeficiency virus

GH

Growth hormone

GHRH

Growth hormone releasing hormone

IGF-1

Insulin-like growth factor-1

IGFBP-3

Insulin-like growth factor binding protein-3

rhGH

Recombinant hormone growth hormone

SAT

Subcutaneous adipose tissue

VAT

Visceral adipose tissue

Notes

Acknowledgments

The authors thank Dr. Angelika Mohn, Dr. Valentina Chiavaroli, and Justina Regina Kanyange for their support.

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Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Edna S. Majaliwa
    • 1
  • Paul Laigong
    • 3
  • Nathan Tumwesigye
    • 4
  • Francesco Chiarelli
    • 2
  1. 1.Muhimbili National HospitalDar es SalaamTanzania
  2. 2.Department of PaediatricsUniversity of ChietiChietiItaly
  3. 3.Gertrudes’ Children’s HospitalNairobiKenya
  4. 4.African Network for the Care of Children Affected by HIV/AIDS (ANECCA), Regional Centre for Quality of Health CareMakerere University School of Public HealthKampalaUganda

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