Growth Parameters in Sudanese Children and Adolescents Living with HIV/AIDS: Findings from a Retrospective Cohort Study

Abstract Background Human immunodeficiency virus (HIV) remains a major global public health problem. Globally, about 39.9 million people are living with HIV (LWHIV), with two-thirds in Africa. HIV infection adversely affects growth in children and adolescents LWHIV. Highly active anti-retroviral therapy (HAART) is shown to improve growth outcomes. In Sudan, WHO estimated that about 4,600 children aged 0-14 are LWHIV, of whom only 15% were receiving antiretroviral treatment in 2023. Data is lacking on growth profile of Sudanese children and adolescents LWHIV. We assessed growth parameters and described clinical and treatment characteristics among Sudanese children living with HIV/AIDS. Methods A cross-sectional study conducted in Omdurman HIV/AIDS Care Unit (OMACU), Tropical Diseases Teaching Hospital, Omdurman, Sudan during January-June 2021. We included a convenient sample of children and adolescents LWHIV presenting for routine outpatient HIV-care. Demographic and clinical data were extracted from medical records. Weight, height, and BMI were measured to assess growth using CDC growth charts. We further performed multivariable analyses to identify factors associated with abnormal growth. R version 4.4.2 was used for data analysis. Results A total of 150 children LWHIV were included (Table 1). Underweight, wasting and stunting were found in 58.7%, 57.3%, and 37.3%; respectively with no significant differences between males and females (Table 2). Children ≥ 10 years of age were significantly adversely affected. Older age at diagnosis was associated with higher odds of abnormal growth (OR 1.32 (1.14, 1.56), p = <0.001). Although perinatal transmission was the predominant mode, HIV was diagnosed late in all children, at a median age of 4 (2, 7) years, with majority (80%) presenting at WHO clinical stage 2 and 3. The most frequently prescribed regimen was Zidovudine/ Lamivudine/Efavirenz (AZT/3TC/EFV) (51%), followed by Zidovudine/Lamivudine/Nevirapine (AZT/3TC/NVP) (30%). The median duration of ART use was 4 years (2, 8). AZT/3TC/NVP regimen was associated with significantly lower odds of abnormal growth in weight and height than AZT/3TC/EFV (OR 0.36 (0.14 – 0.94), p = 0.039). Conclusion This study found high prevalence of suboptimal growth in Sudanese children and adolescents LWHIV. Older children were more adversely affected. Late diagnosis and start of antiretroviral therapy contributed to advanced clinical disease and abnormal growth parameters. Implementation of a comprehensive nationwide universal perinatal HIV-screening is needed to improve timely diagnosis and treatment of HIV-infected children. Additionally, establishing nutritional programs is a crucial step to improve the growth and health of Sudanese children and adolescents LWHIV.