Dysregulation of growth and development in HIV-infected children.

Growth dysregulation is quite common in HIV-infected children and growth failure is one of the most sensitive indicators of disease progression. Beginning at birth, HIV-infected infants often have smaller size and lower birthweight than noninfected children born to HIV-infected women. The causes of growth dysregulation are varied, and can be due to alterations in gastrointestinal function, chronic or repetitive infections, and alterations in metabolic and endocrine function. The metabolic and endocrine effects may be the consequence of the primary infection or secondary to the use of any of the medications required to treat HIV infection and its complications. Correlational studies have identified an inverse relationship between viral burden and linear growth and body mass index, i.e., the use of antiviral medications that reduce viral burden is associated with improvements in anthropometric indices of growth. Alterations in cytokine profiles, possibly related to reported abnormalities in thyroid indices, fat metabolism, and the somatomedin axis, may be indicative of dysregulation on a cellular level. Pubertal delay, especially among boys, is common, and may contribute to the overall growth failure associated with HIV infection. If the basis for growth failure resides in metabolic and regulatory abnormalities, then interventions beyond increasing caloric intake will be necessary to increase linear growth rate and reverse growth failure in HIV-infected children.