Provision of micronutrient-fortified food from 6 months of age does not permit HIV-exposed uninfected Zambian children to catch up in growth to HIV-unexposed children: a randomized controlled trial
Filteau, S.; Baisley, K.; Chisenga, M.; Kasonka, L.; Gibson, R.S.; Filteau, S.; Kasonka, L.; Gibson, R.; Gompels, U.A.; Jaffar, S.; Kafwembe, E.; Monze, M.; Sinkala, M.; Tomkins, A.; Zulu, R.; Chisenga, M.; Siame, J.; Mabuda, H.Banda.; Baisley, K.; Dale, H.; Rehman, A.; Bates, M.; Mullen, A.; Bwalya, H.Kangwa.; Chileshe, M.; Kowa, P.Kangwa.; Kumwenda, M.; Likando, M.; Mambwe, S.; Muzyamba, M.; Mwale, A.; Nyaywa, L.; Kapambwe, M.; Bima, H.; Gosset, L.; Hackett, L.; Jackson, A.; Njunju, E.; Mwanza
Journal of Acquired Immune Deficiency Syndromes 56(2): 166-175
2011
ISSN/ISBN: 1525-4135 PMID: 21119523 DOI: 10.1097/qai.0b013e318201f6c9Document Number: 227006
HIV-exposed, uninfected (HIV-EU) children represent a large proportion of children in southern Africa. The reasons for their poorer growth and higher morbidity and mortality than their HIV-unexposed peers are unclear. We compared anthropometry of 125 HIV-EU with 382 HIV-unexposed young Zambian children participating in a trial of micronutrient-fortified complementary/replacement food. The randomized controlled trial provided children from age 6 to 18 months with a porridge flour containing either a basal or a rich level of micronutrients. Weight and length were measured 3 monthly and head and arm circumferences and triceps and subscapular skinfolds 6 monthly. There were no significant anthropometric differences between the 2 treatment groups. In unadjusted analyses, most anthropometric Z scores of HIV-EU children were lower than those of HIV-unexposed children; after adjustment for treatment arm, socioeconomic factors, breastfeeding and sex, head and arm circumference Z scores remained lower. Subscapular skinfold Z scores were lower among HIV-EU than HIV-unexposed children at 6 months but not 18 months. Socioeconomic factors accounted for some but not all of the impaired growth of HIV-EU children. Micronutrient malnutrition may not be the socioeconomic factor responsible for the growth faltering. Factors acting earlier in life had irreversible effects.