Abstract Ref Number = APCP403
A LONGITUDINAL COHORT STUDY ON TIME TO PERSISTENT STUNTED AND NEWLY STUNTED IN CHILDREN WITH HIV
Ketut Dewi Kumara Wati,Anak Agung Sagung Sawitri,Putu Diah Vedaswari,I Wayan Eka Satriawibawa,Meita Dhamayanti,Budi Setiabudiawan,Ida Parwati
Doctoral Program Faculty of Medicine Universitas Padjadjaran Bandung Indonesia Department of Public Health and Preventive Medicine Faculty of Medicine Udayana University Denpasar, Bali, Indonesia Department of Child Health, Faculty of Medicine, Udayana UniversitySanglah Hospital Denpasar, Bali, Indonesia Department of Child Health, Dr Hasan Sadikin General Hospital, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia Department of Clinical Pathology and Laboratory Medicine, Dr Hasan Sadikin General Hospital, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
Background : Time to occurrence of growth faltering is important in child health context. We sought to determine incidence of persistent and newly stunted, median survival and predictors among children with Human Immunodeficiency virus (HIV) infection using Highly Active Antiretroviral Therapy (HAART)
Material : A combine retrospective and prospective cohort study among 177 children with HIV infection attended Central Hospital in Bali, Indonesia between 2009 and 2018. Children whose aged <14 years-old, started HAART during the period and have repeated height measurement at 3-6 months for at least 1 year were included. Those whose aged <1 month and had incomplete data were excluded. We explored incidence of overal, newly and persistent stunted by Kaplan-Meier analysis. Newly stunted was applied to children within stunted at HAART initiation. Newly and persistent stunted on the follow up examination were defined if they were altering to worsen/persistent condition in the second measurement. Exploration on predictors of stunted using a Cox proportional hazard model with STATA 15.0 version.
Results : In total, 136 subjects were included in the cohort analysis. Stunted at diagnosis was 67.80% and 71.02% at HAART initiation, with median delay of 2 months between those periods. The overal incidence rate for stunted, newly and persistent stunted during 5 years were 46.1, 10.5, and 35.5 per 100 person-years, respectively. Median survival for overal stunted was 0.5 years and persistent stunted was 0.98 years. Stunted at diagnosis giving the highest risk to converting to stunted over 5 years (aHR 5.45; p=0.001, 95% CI 2.97-10.07). Immunosuppresion status and undernutrition at HAART initiation also independent predictors to stunted.
Conclusions : Persistent and newly stunted may develop overtime in children with HIV despite HAART. Half of children have suffering persistent stunted on the first year. Stunted at diagnosis giving 5 times risk for stunted over 5 years.
Keywords: persistent and newly stunted predictor children with HIV HAART