Growth and pubertal development among HIV infected children aged 8-18 years in Dar es salaam

Abstract

Background Advances in management of HIV-infected infants and children have been remarkable, majority of infected children are now surviving into adolescence. Several studies have shown that growth and pubertal development is often impaired among children with HIV and AIDS. Abnormalities include early deficits in height and weight, and delay in skeletal maturation. Onset of menarche and pubertal development are also delayed. The magnitudes of delayed puberty among HIV infected children in Tanzania have not been studied; however there is one unpublished study, which evaluated the growth and pubertal development parameters in the general population. Assessment of the onset and progression of sexual maturation is important in patients with HIV because this information has immediate clinical application in the interpretation of endocrine and growth status. Objective To assess growth and pubertal development among HIV infected children aged 8-18 in Dar es Salaam. Study design and Setting This was a cross section hospital based study at Care and treatment clinics (CTC) municipal Hospitals in Dar es Salaam. Methodology After obtaining informed consent data was collected using a structured questionnaire. Anthropometric measurements of growth and Tanner stages of sexual development of children with HIV and AIDS aged between 8 and 18 years were assessed. Blood was taken to assess CD4 count. Both female and male were classified as having puberty when they are at Tanner stage 2 or greater for breast and genital respectively and pubic hair development in both sexes. Data was analyzed using STATA version 10 statistical packages. vi Results During the study period, 330 HIV infected children were recruited out of whom 183 (55.4 %) were female. The median age of the study populations was 12.0 years. Median weight was 32.0 (IQR 25-45) kg and girls were significantly heavier and had higher BMI than boys. All participants enrolled had HIV which was confirmed and were on ART. Median duration of ART was 48 (IQR 30-62) month. Majority of the participants were in WHO stage III and had CD4 count above 500cells/ul. HIV infected children were found in Tanner stage 2 at an advanced age compared to the reference population. The median age at menarche was 15 (IQR 14-16) years compared to the reference population, which was 13.0 (IQR 12-15) years. Among HIV infected females there was no significant difference in weight, height and BMI compared to the reference population when they entered Tanner stage 2. Males in the reference population were in Tanner stage 2 with higher weight and BMI and they were taller compared with the reference population. In univariable and multivariable analysis advanced age was associated with onset of Tanner stage 2 or more. Conclusion and recommendation Children infected with HIV and AIDS have significant delay in growth and sexual maturation. Considering these findings monitoring of growth and pubertal development should be highly emphasized in this population, it should be part of the comprehensive package. Matched case control studies of HIV-infected and uninfected children are needed to better quantify the delay in pubertal onset and to compare the pace of pubertal maturation.