Clinico-immunological profile and outcome of antiretroviral therapy in HIV-positive children.

Objectives: To study the clinico-immunological, nutritional and growth characteristics of HIV-infected children and the impact of antiretroviral therapy (ART) on these parameters.

Design: Retrospective study.

Setting: Out-patient department of a paediatric ART centre, Delhi, India.

Subjects: HIV-positive children registered at the paediatric ART centre of the hospital were enrolled (n 130). Anthropometric measurements were used to classify children into the type of malnutrition according to definitions of the WHO and US Centers for Disease Control and Prevention. Clinical and immunological status of the children was recorded as per WHO guidelines. First-line ART was started based on guidelines of the National AIDS Control Organization. Nutritional status and clinico-immunological characteristics were followed up annually in children receiving ART.

Results: Of children ≤5 years of age (n 54), stunting was noted in 42·5 % contrary to wasting seen in only 12·9 %. In children >5 years of age (n 76), short stature (40·7 %) and underweight (39·4 %) were seen in almost equal proportions. Asymptomatic presentation was noted in 60·0 %. Following ART, a reduction in wasting was noted in 75·0 % of children ≤5 years of age, whereas only 44·4 % of underweight children >5 years of age showed an improvement after therapy. Stunting and short stature continued to persist in all in children (≤5 years and >5 years, respectively). Clinico-immunologically, 67·5 % improved in clinical status and 62·5 % showed immunological improvement.

Conclusions: ART improves the acute parameters of nutritional status like wasting. It also improves the clinical outcome and restores the immune system. At present first-line ART is effective in HIV-positive children.