Impact of protease inhibitor-containing combination antiretroviral therapies on height and weight growth in HIV-infected children

Objective. To examine beneficial or detrimental effects of protease inhibit or (PI)-containing antiretroviral regimens on height and weight growth in c hildren with human immunodeficiency virus (HIV) infection. Methods. A prospective cohort study was conducted of 906 HIV-infected child ren, from pediatric research clinics in the United States, who were between 3 months and 18 years of age and who had height and weight assessed in 199 5 (before introduction of PIs in this population) and at least once more th rough 1999. Changes in age- and gender-adjusted height and weight growth as sociated with PI use were assessed. Results. Compared with a healthy reference population, children were more a ffected in height (mean z score: -0.90 [18th percentile]) than in weight (m ean z score: -0.42 [34th percentile]) at baseline (1995). Two thirds of chi ldren received at least 1 PI during 1996 to 1999. In the multivariate mixed effects regression models adjusted for baseline log(10) CD4 cell count, ba seline age, gender, and race/ethnicity, the use of PIs was associated with per-year gains of 0.13 z scores in height and 0.05 z scores in weight relat ive to the expected growth with non-PI-containing regimens (eg, after 1 yea r of PI use, a representative 6-year-old boy in our study would be approxim ately 0.7 cm taller and 0.1 kg heavier than if he had not received PIs). No significant differential effects of PIs on height or weight growth accordi ng to specific agents or children's sociodemographic or clinical characteri stics were found. Conclusions. Although the use of PI-containing regimens was not associated with growth retardation, it was associated with only small annual increment s in height and weight growth in HIV-infected children.