ABSTRACT
@#Abstract: Objective To investigate the growth and development of HIV-infected children initiating antiretroviral therapy (ART) and its influencing factors. Methods This retrospective cohort study was conducted in Guangxi. HIV-infected children initiating free antiretroviral therapy (ART) from 2004 to 2019 were included. Z-score was calculated according to the Chinese Child Growth and Development Standard, the Cox-Stuart test was used for trend analysis, and the generalized estimating equation was used to analyze HAZ (Height-for-age Z-score)≥-2 and WAZ (Weight-for-age Z-score)≥-2 influencing factors. Results A total of 943 children with HIV infection were enrolled in the cohort. The median HAZ at baseline and 1, 2, 5, and 10 years after treatment was -2.47, -2.14, -1.94, -1.55, -1.23, respectively, and the median WAZ was -1.85, -1.40, -1.30, -1.21, -1.09, respectively. By Cox-Stuart trend test, HAZ and WAZ showed an upward trend with the treatment time (P<0.05). The proportions of HAZ≥-2 at baseline and at 1, 2, 5, and 10 years after treatment were 38.1%, 46.5%, 51.6%, 66.8%, and 74.6%, respectively, and the proportions of WAZ≥-2 were 57.1%, 76.9%, 81.1%, 85.8% and 89.2%, respectively. According to Cox-Stuart trend test, the proportions of HAZ≥-2 and WAZ≥-2 increased with the treatment time (P<0.05). The results of multivariate generalized estimating equation analysis showed that the associated factors with HAZ≥-2 were that age at ART initiation was 3-7 years old (aOR=0.71, 95%CI: 0.53-0.94), age at ART initiation was >7 years old (aOR=0.66, 95%CI: 0.47-0.93), CD4 cell counts before ART was <200/μL (aOR=0.64, 95%CI: 0.47-0.87), WHO clinical stage before ART was Stage Ⅲ/Ⅳ (aOR=0.74, 95%CI: 0.56-0.97) and time on ART (aOR=1.01, 95%CI: 1.01-1.01); the associated factors with WAZ≥-2 were male (aOR=0.72, 95%CI: 0.53-0.97), WHO clinical stage before ART was Stage Ⅲ/Ⅳ (aOR=0.63, 95%CI: 0.45-0.86) and time on ART (aOR=1.01, 95%CI: 1.01-1.01). Conclusion Antiretroviral therapy can effectively improve the growth and development status of children with HIV infection, but a large proportion of children still have stunted growth and development in the 10th year after treatment. It is necessary to strengthen the training of antiretroviral treatment staff and the publicity and education of parents of children infected with HIV. Improve the effect of antiviral treatment and guide children's nutrition reasonably.