Failure to thrive in HIV-infected children: incidence, prevalence, and clinical correlates.

"Failure to thrive" is a frequent component of the acquired immunodeficiency syndrome (AIDS) in childhood. This retrospective study was conducted to document the incidence, prevalence, and clinical correlates of "failure to thrive" in a cohort of 97 HIV-infected children seen at a large urban teaching hospital over an 8-year period. "Failure to thrive" was defined as percent of body weight for height age < or = 90%. The cumulative incidence of failure to thrive in our cohort was 37/97 (38%), with a current prevalence of 13/97 (14%). When 33 patients with severe symptomatic HIV infection [Centers for Disease Control (CDC) class C] were analyzed separately, the cumulative incidence rose to 22/33 (67%) and current prevalence to 9/33 (27%). CDC class C correlated with failure to thrive (p < 0.001), as did absolute CD4 cell count more than two standard deviations below the mean for age (p < 0.001). Neither the mode of acquisition of HIV infection nor the presence of HIV antigenemia correlated with failure to thrive. During follow-up, 34/37 patients with failure to thrive gained weight; in 17 this was associated with specific nutritional therapy. Treatment with zidovudine (AZT) was also associated with a significant weight gain (p < 0.01). The incidence and prevalence of failure to thrive in our cohort are lower than in previous reports. We conclude that enrollment of HIV-infected children in a comprehensive clinic providing nutritional evaluation, supplemental feeding, treatment of opportunistic infections, antiretroviral medications, and psychosocial support will likely continue to reduce the incidence and prevalence of "failure to thrive."