Abstract:
Introduction: Stunting is a key issue for adolescents with perinatally acquired HIV (APH) that needs to be better understood.
As part of the IeDEA multiregional consortium, we described growth evolution during adolescence for APH on antiretroviral
therapy (ART).
Methods: We included data from sub-Saharan Africa, the Asia-Pacific, and the Caribbean, Central and South America regions
collected between 2003 and 2016. Adolescents on ART, reporting perinatally acquired infection or entering HIV care before
10 years of age, with at least one height measurement between 10 and 16 years of age, and followed in care until at least
14 years of age were included. Characteristics at ART initiation and at 10 years of age were compared by sex. Correlates of
growth defined by height-for-age z-scores (HAZ) between ages 10 and 19 years were studied separately for males and
females, using linear mixed models.
Results: Overall, 8737 APH were included, with 46% from Southern Africa. Median age at ART initiation was 8.1 years (in-
terquartile range (IQR) 6.1 to 9.6), 50% were females, and 41% were stunted (HAZ< 2 SD) at ART initiation. Males and
females did not differ by age and stunting at ART initiation, CD4 count over time or retention in care. At 10 years of age,
34% of males were stunted versus 39% of females (p < 0.001). Females had better subsequent growth, resulting in a higher
prevalence of stunting for males compared to females by age 15 (48% vs. 25%) and 18 years (31% vs. 15%). In linear mixed
models, older age at ART initiation and low CD4 count were associated with poor growth over time (p < 0.001). Those
stunted at 10 years of age or at ART initiation had the greatest growth improvement during adolescence.
Conclusions: Prevalence of stunting is high among APH worldwide. Substantial sex-based differences in growth evolution dur-
ing adolescence were observed in this global cohort, which were not explained by differences in age of access to HIV care,
degree of immunosuppression or region. Other factors influencing growth differences in APH, such as differences in pubertal
development, should be better documented, to guide further research and inform interventions to optimize growth and health
outcomes among APH.