1124. Growth outcomes in children randomized to early versus deferred antiretroviral therapy in the PREDICT study
Session: Poster Abstract Session: Pediatric HIV
Friday, October 19, 2012
Room: SDCC Poster Hall F-H
Posters
  • Thanyawee ID 2012 ver3.pdf (32.5 kB)
  • Background:

    Growth is an important clinical outcome among HIV-infected children receiving antiretroviral therapy(ART).  The PREDICT study reported similar AIDS-free survival and neurocognition in children who were randomized to early vs. deferred ART.  Here we compared the growth parameters between arms.

    Methods:

    This was a substudy of PREDICT, a 144-week randomized trial of early ART (at CD4 15-24%) versus deferred ART (at CD4 < 15%) in 300 ART-naïve Thai and Cambodian children 1-12 years of age with baseline CD4 15-24%.  Growth parameters were measured every 12 weeks and compared to healthy Thai normative data as age-and sex-adjusted weight and height z-scores (WAz, HAz). Changes of WAz and HAz at week 144 compared to baseline were analysed by Wilcoxan rank sum test. Random effect linear regression model was done to study association of  factors on growth change over time. 

    Results:

    The median (IQR) age was 6.4(3.9-8.4) years, CD4 was 20%(17-23%), 42% were male and 60% were Thai. Predictors for baseline WAz < -2 were baseline CD4 < 20% [aOR 2.2 (95% CI 1.2-3.8)] and low hemoglobin [aOR 1.8 (95% CI 1.0-3.1)]. Predictors for baseline HAz < -2 were  HIV RNA > 5 log10 copies/ml [aOR 1.9 (95% CI 1.2-3.1)]; low hemoglobin [aOR 1.9 (95% CI 1.1-3.1)].During 144 weeks of follow-up, 149 and 69 children in the early and deferred arms started ART at  median CD4 percentages of 19% and 14%, respectively. Median changes from baseline of WAz and HAz at week 144 were significantly better in early ART compared to deferred ART arms (Table 1).There were no differences in WAz and HAz changes overtime by baseline CD4 group (<20% and >=20%), age  (< 5 years and >= 5 years), hemoglobin level, HIV RNA level (p>0.05), but treatment arm (p=0.01 and p=0.002, respectively)  

     

    Early (n=150)

    Deferred (n=150)

    p-value

    Weight for age z-score

     

     

     

        Week 0

    -1.33 (-2.00 to -0.75)

    -1.33 (-2.03 to -0.79)

    0.65

        Week 144

    -1.27 (-1.78 to -0.39)

    -1.40 (-1.99 to -0.89)

    0.15

       Change at week144 from baseline

    0.26 (-2.00 to -0.75)

    0.04 (-0.28 to 0.34)

    0.02

    Height for age z-score

     

     

     

        Week 0

    -1.62 (-2.49 to -0.77)

    -1.66 (-2.55 to -0.93)

    0.63

        Week 144

    -1.50 (-2.35 to -0.54)

    -1.73 (-2.42 to -0.95)

    0.09

       Change at week144 from baseline

    0.25 (-0.21 to  0.69)

    -0.02 (-0.40 to 0.34)

    0.004

    Conclusion: Low hemoglobin, low CD4 and high HIV RNA were associated with poor growth at baseline.  After 3 years, children who received early ART at CD4 15-24% had better growth improvements than those who deferred ART until CD4 was below 15%.

    Chaiwat Ngampiyaskul, MD1, Ung Vibol, MD2, Jiratchaya Wongsabut3, Rawiwan Hansudewechakul4, Saphonn Vonthanak, MD5, Pope Kosalaraksa, MD.6, Suparat Kanjanavanit, MD7, Jurai Wongsawat, MD8, Wicharn Luesomboon, MD9, Tulathip Suwanlerk3, Lawrence Fox, MD, PhD10, Jintanat Ananworanich, MD, PhD3,11,12, Kiat Ruxrungtham, MD13,14, Thanyawee Puthanakit, MD3,15 and PREDICT study group, (1)Prapokklao Hospital, Chanthaburi, Thailand, (2)National Pediatric Hospital, Phnom Penh, Cambodia, (3)HIV Netherlands Australia Thailand (HIV-NAT) Research Collaboration, Thai Red Cross AIDS Research Center, Bangkok, Thailand, (4)Chiangrai Prachanukroh Hospital, Chiang Rai, Thailand, (5)National Center for HIV/AIDS, Dermatology and STDs, Phnom Penh, Cambodia, (6)Pediatrics, Khon Kaen University, Khon Kaen, Thailand, (7)Nakornping Hospital, Chiang Mai, Thailand, (8)Bamrasnaradura Infectious Diseases Institute, Nonthaburi, Thailand, (9)Queen Savang Vadhana Memorial Hospital, Bangkok, Thailand, (10)Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, (11)SEARCH, Thai Red Cross AIDS Research Center, Bangkok, Thailand, (12)Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand, (13)HIV Netherlands Australia Thailand (HIV-NAT) Research Collaboration, Thai Red Cross AIDS Research Center Bangkok, Bangkok, Thailand, (14)Chulalongkorn University, Bangkok, Thailand, (15)Department of Pediatrics, Chulalongkorn University, Bangkok, Thailand

    Disclosures:

    C. Ngampiyaskul, None

    U. Vibol, None

    J. Wongsabut, None

    R. Hansudewechakul, None

    S. Vonthanak, None

    P. Kosalaraksa, None

    S. Kanjanavanit, None

    J. Wongsawat, None

    W. Luesomboon, None

    T. Suwanlerk, None

    L. Fox, None

    J. Ananworanich, None

    K. Ruxrungtham, None

    T. Puthanakit, None

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