The effect of protease inhibitor therapy on growth and body composition inhuman immunodeficiency virus type 1-infected children

Objective. To determine the effect of protease inhibitors (PIs) on growth a nd body composition in children with human immunodeficiency virus type 1 (H IV-1) infection. Background. HIV-1-infected children have chronic problems with both linear growth and weight gain. Viral load may directly influence growth and nutrit ional status of HIV-1-infected children with reduction of viral load improv ing the nutritional condition. Design/Methods. Data from 67 patients who initiated PI therapy between 1996 and 1999 and who were enrolled in a prospective, longitudinal study of gro wth and nutrition in HIV-1-infected children were analyzed. Outcomes includ ed pre-PI versus post-PI measures of height, weight, weight-for-height, tri ceps skinfold thickness, and arm muscle circumference. Predictor covariates included age, race, gender, Tanner stage, CD4 z score, Centers for Disease Control and Prevention stage, route of infection, plasma HIV-1 RNA, other antiretroviral therapy, recommended daily allowances for calories, treatmen t with megestrol acetate, and PI therapy. Results. Sixty-seven children were followed for a median of 2.4 years with a total of 362 visits (median: 5 visits; range: 1-12). During follow-up, th ey received PIs for a median of 5 months. Fifty-one percent were girls, 54% black, 15% Hispanic, and 25% white. The mean age at first visit was 6.8 ye ars. In a univariate analysis, weight z score (-0.67 to -0.35) and weight/h eight z score (0.25-0.76) improved on PI therapy. Using repeated-measures r egression analysis, controlling for the above named covariates, PI treatmen t showed a significant effect on weight z score (increase in z score by 0.4 6), weight/height z score (increase in z score by 0.49), and arm muscle cir cumference (increase in percentile by 11.5). A borderline effect was found for height z score (increase in z score by 0.17) and no effect was found fo r triceps skin-fold thickness. In a separate analysis, PI therapy increased CD4 counts twofold and reduced plasma HIV-1 RNA copies by 79%. Conclusion. In addition to a significant reduction in viral load, PI therap y in children has a positive effect on several growth parameters, including weight, weight/height, and muscle mass.