Growth, survival and viral load in symptomatic childhood human immunodeficiency virus infection

Background. The relationships among weight and height growth, viral load and survival in HIV-infected children remain unclear. Objectives. To determine whether weight or height growth velocity independently predicts survival and to investigate associations of weight, height and head circumference growth velocities with viral loads in symptomatic HIV-infected children. Methods. We analyzed data from a prospective antiretroviral study utilizing clinical endpoints (PACTG 152). Viral load [log(RNA PCR)] and anthropometric measures 12 weeks before and after viral load measures were available in 494 of 831 children. Interval changes during 24 weeks in z-scores for weight-for-age (DeltaWAZ), height-forage (DeltaHAZ) and head circumference-for-age (DeltaHCZ) were used as growth velocity surrogates. Logistic regression determined whether DeltaWAZ and/or DeltaHAZ correlated with survival when age, viral load and CD4(+) cell count were controlled. Bivariate analysis assessed correlation among viral load and DeltaWAZ, DeltaHAZ and/or DeltaHCZ. Results. Survival related significantly to height growth velocity (P = 0.03, n = 434) but not to weight growth velocity (P = 0.84, n = 446) or head circumference growth velocity (P = 0.67, n = 148). Viral load was not significantly associated with changes in weight-, height-, or head circumference-for-age z scores (P = 0.86, n = 235; P = 0.07, n = 226; and P = 0.09, n = 165, respectively) in children <30 months of age or with changes in weight- or height-for-age z scores (P = 0.27, n 259; P = 0.11, n = 251) in older children. Conclusions. Height growth velocity predicted survival independently of age, viral load and CD4(+) cell count. Weight, height and head circumference growth velocities were not significantly associated with viral load in symptomatic HIV-infected children in this large prospective trial of nucleoside reverse transcriptase therapy.