Stunting and growth development for adolescents perinatally infected by HIV: males and females evolve differently.

Transcription

1 Stunting and growth development for adolescents perinatally infected by HIV: males and females evolve differently. A multiregional analysis from the IeDEA global pediatric collaboration. Julie Jesson, Michael Schomaker, Karen Malasteste, Dewi Kumara Wati, Azar Kariminia, Mariam Sylla, Kouakou Kouadio, Shobna Sawry, Mwangelwa Mubiana-Mbewer, Samuel Ayaya, Rachel Vreeman, Catherine C. McGowan, Marcel Yotebieng, Mary-Ann Davies, Valériane Leroy, on behalf of the IeDEA global cohort consortium 10th HIV Pediatrics- 21st July 2018 Nothing to disclose

2 Perinatally HIV infected adolescents (PHA) PHA are a vulnerable group, facing many challenges (transition, disclosure, reproductive health, morbidity due to long-term antiretroviral therapy..) One of these challenges: growth retardation and stunting Estimates on stunting: 1/3 children <5y in developing countries What about adolescents? No estimates For the global population of 10-19y, neglected group for nutritional care For HIV-infected adolescents, no specific nutritional recommendations WHO First results on HIV-infected adolescents (abstract 8) High rates of stunting Differences of growth evolution between males and females Heterogeneity of population (perinatally and behaviourally HIV infected) 2

3 Objective and inclusion criteria To describe growth evolution and its associated factors for PHA To investigate differences between males and females Inclusion criteria: HIV-infected adolescents from the global IeDEA cohort between 2003 and 2016 On antiretroviral therapy Known as perinatally infected or, if unknown, entering HIV care <10y of age At least 1 height measurement between 10 and 16y of age Followed in care until at least 14y of age PHA, or in care<10y 1 height measurement In care 14y 10y 14y 16y 19y 3

4 Methods Growth (WHO child growth standards), compared by sex Height-for-Age Z-score (HAZ), Stunting = HAZ<-2 SD Growth velocity = Height gains in cm per year Variables compared by sex Characteristics at ART initiation: age, CD4 count, stunting Characteristics at 10y of age: CD4 count, stunting Follow-up characteristics Associated factors to HAZ evolution For males and females separately Linear mixed models Source: Schneider,

5 5 Total N=8,737 (100%) IeDEA platform N=706 (8%) N=1,541 (18%) N=400 (5%) N=1,496 (17%) N=613 (7%) N=3,984 (46%)

6 Characteristics of the population 6 Variables Total (N=8,737) Females, % 50 Age at ART initiation, years median [IQR] CD4 count< 250/mL at ART initiation, % CD4 count< 250/mL at 10y of age, % 8.1 [ ] 25 Stunting at ART initiation, % 41 7 No significant differences by sex Variables Age at enrolment, years median [IQR] Age at last visit, years median [IQR] Drop-out* during adolescence, % Death during adolescence % Total (N=8,737) 7.1 [ ] 16.1 [ ] 24 *Transfer, Lost-to-follow-up (regionspecific definitions) 2

7 Description of growth evolution by sex p=0.092 * * * * * * * * * Age (years) % Males Stunting Females * p<

8 Height-for-Age Z-score Height-for-Age Z-score Trends by regions 8 West Africa, N=706 Central Africa, N=400 Asia-Pacific, N=1541 Southern Africa, N=3984 East Africa, N=1493 CCASAnet, N=613 Age (years) Age (years) Age (years)

9 Associated factors to HAZ evolution Age at ART initiation Difference of estimates in mean Z-scores 0-2y Males Females Variables For males For females At 10y 10-19y At 10y 10-19y 2-5y At ART initiation 5-10y 0-2y vs 5-10y +0.49* * y vs 5-10y +0.19* +0.07* CD4 <250 vs > * +0.04* At 10 years of age Males Age (years) Age (years) Severity of stunting at 10y of age Females Severely stunted vs no Moderately stunted vs no -1.83* +0.08* -1.92* +0.12* -0.90* * +0.09* No Mode rately *=p<0.001, =p<0.05 Multivariate models adjusted on regions, stunting at ART initiation and CD4 at 10 years of age Severe Graphs (left): Observed (non adjusted) curves of HAZ evolution between 10 and 19 years of age. Age (years) Age (years) 9

10 Conclusions, synthesis of the results High prevalence of stunting among PHA, more pronounced for males Growth spurt less pronounced for PHA but important height gains during late adolescence The most stunted at 10y were those initiated later on ART (>5y) severely immunodeficient at ART initiation (CD4<250) Growth evolution was consistent between regions, highest for the most stunted At 19 years of age Females have finished to grow, catch-up growth for the most stunted obtained Males continue to grow, catch-up growth not obtained yet 10

11 Why this growth difference between males and females? No differences between males and females according to Characteristics at ART initiation (CD4, age, stunting), CD4 count at 10y of age Follow-up characteristics (age at inclusion, age at last follow-up), drop-out and death rates Hypotheses Puberty delay more pronounced for males than females? Szubert al al, AIDS 2015: similar puberty delay with height disadvantage for males Different effects of hormonal pathways on PHA males and females? Different nutritional habits? same trends in every region Jacobson et al. AIDS 2010: lower bone mineral density for PHA males compared to non-hiv males in puberty stages 3 to 5, not for females.? Growth is a real challenge for PHA and needs to be better understood, males not to be left behind on this topic 11

12 Acknowledgments All adolescents enrolled in the IeDEA consortium All co-authors and investigators from the IeDEA regions Research team from the University of Toulouse, France Research team from the University of Cape Town, CIDER, South Africa Valériane Leroy, Mary-Ann Davies, Michael Schomaker The International Epidemiology Databases to Evaluate AIDS (IeDEA) is supported by the U.S. National Institutes of Health s National Institute of Allergy and Infectious Diseases, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the National Cancer Institute, the National Institute of Mental Health, and the National Institute on Drug Abuse: Asia-Pacific, U01AI069907; CCASAnet, U01AI069923; Central Africa, U01AI096299; East Africa, U01AI069911; NA-ACCORD, U01AI069918; Southern Africa, U01AI069924; West Africa, U01AI This work is solely the responsibility of the authors and does not necessarily represent the official views of any of the governments or institutions mentioned above. 12