Pubertal development in HIV-infected African children on first-line antiretroviral therapy.
OBJECTIVES: To estimate age at attaining Tanner stages in Ugandan/Zimbabwean HIV-infected children initiating antiretroviral therapy (ART) in older childhood and investigate predictors of delayed puberty, particularly age at ART initiation. DESIGN: Observational analysis within a randomized trial. M...
| Autors principals: | , , , , , , , , |
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| Format: | Journal article |
| Idioma: | English |
| Publicat: |
Lippincott, Williams and Wilkins
2015
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| _version_ | 1826302684182872064 |
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| author | Szubert, A Musiime, V Bwakura-Dangarembizi, M Nahirya-Ntege, P Kekitiinwa, A Gibb, D Nathoo, K Prendergast, A Walker, A |
| author_facet | Szubert, A Musiime, V Bwakura-Dangarembizi, M Nahirya-Ntege, P Kekitiinwa, A Gibb, D Nathoo, K Prendergast, A Walker, A |
| author_sort | Szubert, A |
| collection | OXFORD |
| description | OBJECTIVES: To estimate age at attaining Tanner stages in Ugandan/Zimbabwean HIV-infected children initiating antiretroviral therapy (ART) in older childhood and investigate predictors of delayed puberty, particularly age at ART initiation. DESIGN: Observational analysis within a randomized trial. METHODS: Tanner staging was assessed every 24 weeks from 10 years of age, menarche every 12 weeks and height every 4-6 weeks. Age at attaining different Tanner stages was estimated using normal interval regression, considering predictors using multivariable regression. Growth was estimated using multilevel models with child-specific intercepts and trajectories. RESULTS: Median age at ART initiation was 9.4 years (inter-quartile range 7.8, 11.3) (n = 582). At the first assessment, the majority (80.2%) were in Tanner stage 1; median follow-up with staging was 2.8 years. There was a strong delaying effect of older age at ART initiation on age at attaining all Tanner stages (P < 0.05) and menarche (P = 0.02); in boys the delaying effect generally weakened with older age. There were additional significant delays associated with greater impairments in pre-ART height-for-age Z-score (P < 0.05) in both sexes and pre-ART BMI-for-age in girls (P < 0.05). There was no evidence that pre-ART immuno-suppression independently delayed puberty or menarche. However, older children/adolescents had significant growth spurts in intermediate Tanner stages, and were still significantly increasing their height when in Tanner stage 5 (P < 0.01). CONCLUSION: Delaying ART initiation until older childhood substantially delays pubertal development and menarche, independently of immuno-suppression. This highlights that factors other than CD4, such as pubertal development, need consideration when making decisions about timing of ART initiation in older children. |
| first_indexed | 2024-03-07T05:51:17Z |
| format | Journal article |
| id | oxford-uuid:e8f7cc8f-3539-4eb0-a2ed-04de50299bb5 |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-07T05:51:17Z |
| publishDate | 2015 |
| publisher | Lippincott, Williams and Wilkins |
| record_format | dspace |
| spelling | oxford-uuid:e8f7cc8f-3539-4eb0-a2ed-04de50299bb52022-03-27T10:50:45ZPubertal development in HIV-infected African children on first-line antiretroviral therapy.Journal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:e8f7cc8f-3539-4eb0-a2ed-04de50299bb5EnglishSymplectic Elements at OxfordLippincott, Williams and Wilkins2015Szubert, AMusiime, VBwakura-Dangarembizi, MNahirya-Ntege, PKekitiinwa, AGibb, DNathoo, KPrendergast, AWalker, AOBJECTIVES: To estimate age at attaining Tanner stages in Ugandan/Zimbabwean HIV-infected children initiating antiretroviral therapy (ART) in older childhood and investigate predictors of delayed puberty, particularly age at ART initiation. DESIGN: Observational analysis within a randomized trial. METHODS: Tanner staging was assessed every 24 weeks from 10 years of age, menarche every 12 weeks and height every 4-6 weeks. Age at attaining different Tanner stages was estimated using normal interval regression, considering predictors using multivariable regression. Growth was estimated using multilevel models with child-specific intercepts and trajectories. RESULTS: Median age at ART initiation was 9.4 years (inter-quartile range 7.8, 11.3) (n = 582). At the first assessment, the majority (80.2%) were in Tanner stage 1; median follow-up with staging was 2.8 years. There was a strong delaying effect of older age at ART initiation on age at attaining all Tanner stages (P < 0.05) and menarche (P = 0.02); in boys the delaying effect generally weakened with older age. There were additional significant delays associated with greater impairments in pre-ART height-for-age Z-score (P < 0.05) in both sexes and pre-ART BMI-for-age in girls (P < 0.05). There was no evidence that pre-ART immuno-suppression independently delayed puberty or menarche. However, older children/adolescents had significant growth spurts in intermediate Tanner stages, and were still significantly increasing their height when in Tanner stage 5 (P < 0.01). CONCLUSION: Delaying ART initiation until older childhood substantially delays pubertal development and menarche, independently of immuno-suppression. This highlights that factors other than CD4, such as pubertal development, need consideration when making decisions about timing of ART initiation in older children. |
| spellingShingle | Szubert, A Musiime, V Bwakura-Dangarembizi, M Nahirya-Ntege, P Kekitiinwa, A Gibb, D Nathoo, K Prendergast, A Walker, A Pubertal development in HIV-infected African children on first-line antiretroviral therapy. |
| title | Pubertal development in HIV-infected African children on first-line antiretroviral therapy. |
| title_full | Pubertal development in HIV-infected African children on first-line antiretroviral therapy. |
| title_fullStr | Pubertal development in HIV-infected African children on first-line antiretroviral therapy. |
| title_full_unstemmed | Pubertal development in HIV-infected African children on first-line antiretroviral therapy. |
| title_short | Pubertal development in HIV-infected African children on first-line antiretroviral therapy. |
| title_sort | pubertal development in hiv infected african children on first line antiretroviral therapy |
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