Patterns of linear growth among children and adolescents living with HIV on antiretroviral therapy in Zimbabwe and Zambia

Background Adolescents with HIV (AWH) frequently exhibit impaired growth, which manifests as stunting and wasting. We studied trajectories in leg-length (appendicular), sitting (axial), and standing height among AWH on antiretroviral therapy (ART), determining peak height velocity (PHV) and age at PHV (aPHV). Methods Analyses used VITALITY trial data from Zimbabwe and Zambia (PACTR20200989766029), which recruited AWH (11-19 years) established on ART to determine whether vitamin D-3/calcium supplementation improves bone health. The study enrolled participants between January and December 2021. Weight-for-age and height-for-age z-scores (WAZ/HAZ) were calculated from 12-weekly anthropometry over 96 weeks. Height trajectory analyses used SuperImposition by Translation And Rotation (SITAR) methods adjusting for height, tempo (aPHV) and velocity. Linear associations between vitamin D/calcium supplementation, HIV-specific factors, WAZ, HAZ, and SITAR parameters were determined. Results Overall, 842 participants (53<middle dot>2% female; median age 15<middle dot>5 [IQR:13<middle dot>2-17<middle dot>9] years), were taking ART for median 9<middle dot>8(IQR:6<middle dot>3-12<middle dot>3) years. Mean(SD) HAZ was 1<middle dot>21(1<middle dot>05) in females, -1<middle dot>68(1<middle dot>05) in males. Overall, 251(29<middle dot>8%) AWH were stunted (HAZ < -2) and 253(30%) wasted (WAZ < -2). Standing, appendicular and axial aPHVs were: Female 13<middle dot>4, 13<middle dot>3, 13<middle dot>9 years; Males 15<middle dot>3, 15<middle dot>0, 15<middle dot>8 years. Unsuppressed viral-load(VL) and delayed ART initiation (age > 4-years) were associated with later aPHV and shorter axial height in females. In all, unsuppressed VL had a more negative effect on aPHV for axial (Females: beta = 0<middle dot>39 years [95%CI:0<middle dot>12,0<middle dot>65]; Males: beta = 0<middle dot>45 [95%CI:0<middle dot>10,0<middle dot>80]) than appendicular growth (Females: beta = 0.31 [95%CI 0<middle dot>08,0<middle dot>53]; Males: beta = 0<middle dot>2 [95%CI:-0<middle dot>17,0<middle dot>56]). Conversely, delayed ART initiation was more negatively related to aPHV for appendicular (Females: beta = 0<middle dot>25 [95% CI:0<middle dot>08,0<middle dot>43]; Males: beta = 0<middle dot>63 [95%CI:0<middle dot>32, 0<middle dot>93] than axial growth (Females: beta = 0<middle dot>13 [95%CI:-0<middle dot>08,0<middle dot>34]; Males: beta = 0<middle dot>56 [95%CI:0<middle dot>28,0<middle dot>86]. Lower HAZ and WAZ were associated with lower height, later aPHV and lower PHV. At 48-week vitamin-D-3/calcium supplementation had no effect on the growth pattern. Conclusion Unsuppressed viral load and delayed ART-initiation predicted later aPHV. Stunting and wasting were associated with attenuated growth velocity and later aPHV. Adolescents with HIV experience persistent linear growth impairments, potentially persisting into adulthood.