***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE To describe the effects of age at antiretroviral therapy ( ART ) initiation on growth outcomes among children infected with HIV followed for 48 months after treatment initiation . STUDY DESIGN This secondary analysis describes anthropometric changes in children infected with HIV in Johannesburg , South Africa who initiated ritonavir-boosted lopinavir-based ART before 24 months of age and were r and omized to continue ritonavir-boosted lopinavir or to receive nevirapine after achieving and maintaining virologic suppression . Weight , height , and head circumference were measured at visits over 48 months post-ART initiation . Growth patterns including weight-for-age z-scores ( WAZs ) , height-for-age z-scores , body mass index-for-age z-scores , and head circumference for age z-score were compared between children initiating ART<6 months , 6 - 12 months , and 12 - 24 months of age . RESULTS A total of 195 children ( mean±SD age 10.7±5.9 months ) , including 54 (27.7%)<6 months , 69 ( 35.4 % ) 6 - 12 months , and 72 ( 36.9 % ) 12 - 24 months of age at ART initiation , were evaluated . In the first 12 months on treatment , children<6 months of age at ART initiation experienced more rapid improvement in WAZ ( 1.98 vs 1.44 , P=.084 ) and head circumference for age z-score ( 1.24 vs 0.45 , P=.004 ) than children who initiated ART between 12 - 24 months of age . By 48 months on ART , growth outcomes were similar , regardless of age at ART initiation . WAZ approached population norms by 12 months on ART . Although improving , height-for-age z-scores remained on average 1.0 z-score below population norms at 48 months of therapy . CONCLUSIONS Initiation of ART before 6 months of age results in more rapid growth recovery in children infected with HIV . These data provide further evidence for the importance of prompt diagnosis and early initiation of ART for infants infected with HIV Background : We assessed a nutritional support intervention in malnourished HIV-infected children in a HIV-care program of the University Hospital Gabriel Touré , Bamako , Mali . Methods : All HIV-infected children younger than 15 years were diagnosed for malnutrition between 07 and 12 , 2014 . Malnutrition was defined according to the WHO growth st and ards with Z-scores . Two types were studied : acute malnutrition ( AM ) and chronic malnutrition ( CM ) . All participants were enrolled in a 6-month prospect i ve interventional cohort , receiving Ready-To-Use Therapeutic Food , according to type of malnutrition . The nutritional intervention was offered until child growth reached −1.5 SD threshold . Six-month probability to catch up growth ( > −2 SD ) was assessed for AM using Kaplan-Meier curves and Cox model . Results : Among the 348 children screened , 198 ( 57 % ) were malnourished of whom 158 ( 80 % ) children were included : 97 ( 61 % ) for AM ( 35 with associated CM ) and 61 ( 39 % ) with CM . Fifty-nine percent were boys , 97 % were on antiretroviral therapy , median age was 9.5 years ( Interquartile Range : 6.7–12.3 ) . Among children with AM , 74 % catch-up their growth at 6-month ; probability to catch-up growth was greater for those without associated CM ( adjusted Hazard Ratio = 1.97 , CI 95 % : 1.13 to 3.44 ) . Anemia decreased significantly from 40 % to 12 % at the end of intervention ( P < 0.001 ) . Conclusions : This macronutrient intervention showed 6-month benefits for weight gain and reduced anemia among these children mainly on antiretroviral therapy for years and aged greater than 5 years at inclusion . Associated CM slows down AM recovery and needs longer support . Integration of nutritional screening and care in the pediatric HIV-care package is needed to optimize growth and prevent metabolic disorders Background Data on long-term toxicity of antiretroviral therapy ( ART ) in HIV-infected children are sparse . PENPACT-1 was an open-label trial in which HIV-infected children were assigned r and omly to receive protease inhibitor (PI)- or nonnucleoside reverse-transcriptase inhibitor (NNRTI)-based ART . Methods We examined changes in clinical , immunologic , and inflammatory markers from baseline to year 4 in the subset of children in the PENPACT-1 study who experienced viral suppression between week 24 and year 4 of ART .  Liver enzyme , creatinine , and cholesterol levels and hematologic parameters were assessed during the trial . Cystatin C , high-sensitivity C-reactive protein ( hs-CRP ) , interleukin 6 ( IL-6 ) , d-dimer , and soluble CD14 ( sCD14 ) were assayed from cryopreserved specimens . Results Ninety-nine children ( 52 on PI-based and 47 on NNRTI-based ART ) met inclusion criteria . The median age at initiation of ART was 6.5 years ( interquartile range [ IQR ] , 3.7 - 13.4 years ) , and 22 % were aged <3 years at ART initiation ; 56 % of the PI-treated children received lopinavir/ritonavir , and 70 % of NNRTI-treated children received efavirenz initially . We found no evidence of significant clinical toxicity in either group ; growth , liver , kidney , and hematologic parameters either remained unchanged or improved between baseline and year 4 . Total cholesterol levels increased modestly , but no difference between the groups was found . IL-6 and hs-CRP levels decreased more after 4 years in the NNRTI-based ART group . The median change in IL-6 level was -0.35 pg/ml in the PI-based ART group and -1.0 in the NNRTI-based ART group ( P = .05 ) , and the median change in hs-CRP level was 0.25 µg/ml in the PI-based ART group and -0.95 µg/ml in the NNRTI-based ART group ( P = .005 ) . Conclusion These results support the safety of prolonged ART use in HIV-infected children and suggest that suppressive NNRTI-based regimens can be associated with lower levels of systemic inflammation INTRODUCTION Growth failure is a common feature of children with human immunodeficiency virus type 1 ( HIV-1 ) infection . Children who are treated with mono or dual nucleoside analogue reverse transcriptase inhibitor ( NRTI ) therapy  show a temporary increase in weight gain and linear growth rate . In adults , protease-inhibitor-containing antiretroviral therapy is associated with a sustained weight gain and increased body mass index ( BMI ) . Experience with protease inhibitors and growth in children is still limited . The data mainly deal with short-term effects on growth . OBJECTIVE To evaluate the effect of highly active antiretroviral therapy ( HAART ) on growth in children with HIV-1 infection . DESIGN AND METHODS We analyzed selected growth parameters , clinical data , and laboratory results as part of a prospect i ve , open , uncontrolled , multicenter study to evaluate the clinical , immunologic , and virologic response to HAART consisting of indinavir , zidovudine , and lamivudine in children with HIV-1 infection . Height and weight were measured at 0 , 12 , 24 , 36 , 48 , 60 , 72 , 84 , and 96 weeks after initiation of HAART . Information about the children 's growth before enrollment in the study was retrieved from the hospital medical records and /or the school doctor or health center . BMI was calculated . z Scores were used to express the st and ard deviation ( SD ) in SD units from the Dutch reference curves for age and gender . Viral loads and CD4 + T-cell counts were examined prospect ively and related to these growth parameters . z Scores were also calculated for CD4 + T-cell counts to correct for age-related differences . A z score of 0 represents the P50 , which is exactly the age/sex-appropriate median . A height z score of -1 indicates that a child 's height is 1 SD below the age- and gender-specific median height for the normal population . Virologic responders were defined as those who either reached an undetectable viral load ( < 500 copies/mL ) or had a > 1.5 log reduction in viral load compared with baseline at week 12 after the initiation of HAART , which was maintained during the follow-up period . RESULTS . PATIENTS Twenty-four patients were included ( age : 0.4 - 16.3 years at baseline ) , with a median HIV-1  RNA load of 105 925 copies/mL ( 5.03 log ) , a median CD4 + T-cell count of 0.586 x 10(9)/L ( median z score : -2.28 SD ) , a median height z score of -1.22 , a median weight z score of -0.74 , and a median baseline BMI z score of -0.32 . Eleven patients were naive to antiretroviral therapy , and 13 patients had received previous treatment with NRTI monotherapy .  Twenty children used indinavir and 4 children used nelfinavir as part of HAART . VIROLOGIC AND IMMUNOLOGIC RESPONSES TO HAART :  Seventeen children were virologic responders , and 7 children were virologic nonresponders . In patients naive to NRTIs , median baseline viral loads were significantly higher than in pretreated patients . However , at weeks 48 and 96 , there was no significant difference between the viral loads of both groups . At baseline , there was no significant difference in CD4+a T-cell z scores between virologic responders and nonresponders or between naive and pretreated patients . During 96 weeks of HAART , the increase of CD4 + T-cell z score was significantly higher in responders than in nonresponders . The increase in CD4 + T-cell z score was not significantly different for naive and pretreated patients . HEIGHT , WEIGHT , AND BMI z SCORE CHANGES : We found that there was a trend toward a significantly increased z score change during 96 weeks of HAART compared with the z score change before HAART initiation for height and weight , but not for BMI . GROWTH AND VIROLOGIC RESPONSE TO HAART : When the data were analyzed separately for virologic responders and nonresponders , virologic responders showed significant increases in height and weight . The height and weight of virologic nonresponders did not change significantly . The BMI did not change significantly in responders or in nonresponders . GROWTH AND IMMUNOLOGIC RESPONSE TO HAART : The increase of weight and BMI z scores from baseline correlated positively with the CD4 + T-cell z score increase from baseline . It did not correlate with absolute CD4 + T-cell count increase . Height z score increase did not correlate with CD4 + T-cell z score or with absolute CD4 + T-cell counts . GROWTH AND PREVIOUS NRTI TREATMENT : The height z score decrease from week -48 to baseline was significantly larger in naive than in pretreated patients . The weight and BMI z score change from week -48 to baseline was not significantly different for pretreated and naive patients . From baseline to week 96 , the height and weight z score change increased significantly in naive patients but not in pretreated patients compared with the change from week -48 to baseline . The BMI z score did not change significantly over 96 weeks of HAART for naive or pretreated patients . GROWTH AND CLINICAL STAGE OF INFECTION : The clinical stage of infection according to the Centers for Disease Control and Prevention classification correlated negatively with the BMI z score and the weight z score at baseline but not with the height z score . Thus , children with the most severe clinical disease had the lowest BMI and weight z scores at baseline . The BMI z score increased more in children with more advanced clinical infection at baseline , who had lower BMI at baseline . The clinical stage of infection did not correlate with the change in weight z score from baseline to week 96 . CONCLUSIONS HAART has a positive influence effect on the growth of HIV-1-infected children . This effect is sustained for at least 96 weeks . Height and weight are favorably influenced in children in whom HAART leads to a reduction of the viral load of at least 1.5 log or to < 500 copies/mL and to an increase in the CD4 + T-cell z score . In contrast to the increase of the BMI in adults on HAART , BMI did not increase in all children effectively treated with HAART . BMI increased more in children with an advanced stage of infection and a poor nutritional status at baseline . Data from pretreated and naive patients were difficult to interpret , because the baseline characteristics of these 2 groups differed too much OBJECTIVE To evaluate the nature and magnitude of the effect of congenitally or perinatally acquired human immunodeficiency virus ( HIV ) infection on somatic growth from birth through 18 months of age . STUDY DESIGN Anthropometry was performed serially in 282 term infants born to HIV-infected women in a multicenter prospect i ve 
    Output:
    
DATA SYNTHESIS Antiretroviral therapy has significantly reduced morbidity and mortality in HIV-infected children and is clearly associated with recovery of weight and height-for-age Z-scores , especially when started early , in the asymptomatic child still without weight-height impairment .
CONCLUSIONS HIV-infected children show early  weight-height impairment ;  antiretroviral therapy improves the anthropometric profile of these children