August 16, 2006 (AIDSmeds)—New data reported at the XVI International AIDSConference (IAC) in Toronto indicates that HIV treatment dramaticallyimproves growth and body composition in HIV-positive children.In fact, the AIDS Clinical Trials Group study concludes thatHIV-positive children starting or switching HIV treatment actually havehigher gains in weight, height, and lean body mass than HIV-uninfectedchildren.

Numerous studies have demonstrated thatHIV-positive children suffer from poor growth and body composition(water, fat, and muscle), which has been shown to be associated withmore rapid disease progression. While the exact cause, or causes, ofpoor growth in these children has not been fully determined, datacollected over the past ten years suggests that HIV treatment can leadto improvements in growth and body composition.

PediatricAIDS Clinical Trials Group study 1010, reported during an IAC sessionon Monday by Caroline Chantry, MD, of the University of CaliforniaDavis Medical Center, was conducted to evaluate changes in growth inchildren starting or changing HIV treatment. It was a 48-week clinicaltrial that enrolled HIV-positive children between one month and 13years of age. All children were either starting treatment or switchingto a protease inhibitor-based regimen for the first time.

Ninety-sevenpediatric patients were enrolled. Nine percent were infants, 15% weretoddlers, 34% were between three and eight years of age, and 41% werebetween eight and 13 years of age. The average viral load upon entering the study was approximately 50,000 and the average CD4 cell percentage(T cell percentage) – considered to be a more accurate measure of CD4cell function in children – was 25%. Twenty-nine percent of thechildren were starting treatment for the first time and 24% wereswitching to a protease inhibitor-based regimen for the first time.

TheHIV-positive children were compared to a large cohort of 6,819HIV-negative children participating in the National Health andNutrition Examination Survey (NHANES).

After 48 weeksof treatment, which was chosen for each patient by the studyresearchers, 54% of the children had viral loads below 50. There werealso significant increases in weight and height, along with asignificant increase in fat-free mass, a good indicator of improvedbody composition.

Additional analysis of the studydata demonstrated that the status of the children at study entry – notthe viral load and CD4 count responses to therapy, nor the HIVtreatments used during the study – was the best predictor of growth andbody composition improvements. Lower body composition, CD4 cellpercentage, and age at study entry were predictive of the greatestincreases in weight. As for height, waist circumference, body fatpercentage, and body composition measurements of triceps skinfoldthickness and mid-arm muscle circumference, a lower body mass atbaseline was the most predictive value.

Finally,compared to the children of similar ages in the NHANES cohort, theHIV-positive children – after 48 weeks of treatment – had significantlygreater body weight, height, and fat-free mass. In other words, notonly does HIV treatment improve growth and body composition inHIV-positive children, it actually boosts healthy growth and bodycomposition to above-normal levels. These data, the study authorsconcluded, are encouraging.