IMPAIRED EARLY GROWTH OF INFANTS PERINATALLY INFECTED WITH HUMAN-IMMUNODEFICIENCY-VIRUS - CORRELATION WITH VIRAL LOAD

Objective: To evaluate the effect of viral load on the early growth of infants infected with human immunodeficiency virus (HIV). Methods: Pl asma concentrations of p24-antigen and HIV ribonucleic acid were measu red retrospectively and correlated with growth parameters for the firs t 18 months of life in a cohort of 47 term infants born to HIV-infecte d mothers prospectively enrolled in a study of perinatal HIV transmiss ion. Comparisons of the mean weight and length of the 18 HIV-infected and 29 uninfected infants for each interval and across intervals were made. Viral load was correlated with standard deviation scores. Infant s were stratified by high and low viral load during the first 6 months of life. Results: At birth, no difference in weight and length was ob served between HIV-infected and uninfected infants. Between birth and 6 months of age, the infected infants grew less rapidly than the uninf ected infants, a finding temporally associated with an exponential inc rease in HIV viremia. The linear growth of infected infants remained c onsistently less than that of the uninfected infants after 6 months of life, although the differences were no longer statistically significa nt and tended to decrease with age in parallel with declines in viral load. The median plasma concentration of HIV ribonucleic acid was sign ificantly higher at 3, 6, 12, and 18 months in infected infants in who m growth failure developed. Infants who had a high viral load in the f irst 6 months of life were significantly more likely to have severe gr owth failure. Though the mean SD for weight of the infected infants wa s always less than that of the uninfected infants, the differences wer e small and not significant. Conclusions: Our results confirm the obse rvation that stunting is an early frequent finding in perinatal HIV in fection. The deleterious effect of HIV on linear growth appears to be correlated with the level of postnatal HIV viremia, although the exact mechanism of this association remains to be elucidated.