Abstract 507 Poster Session I, Saturday, 5/1 (poster 295)

Protease inhibitors (PI's) have positive effects (e.g., increase weight gain) in HIV-1-infected adults with wasting. Anecdotally, PI's are said to improve height and weight in HIV-1-infected children, but no long-term study results have been reported to date. Thus, we retrospectively analyzed bi-monthly height and weight measurements from 14 perinatally HIV-1-infected children (4 girls and 10 boys; ages 2.3-13.2 yr) who had been on antiretroviral therapy (ART) for at least 10 mo prior to addition of PI's and who continued on PI's for at least 18 mo. The majority of patients were asymptomatic or mildly symptomatic at baseline. The mean ± 1SD height velocity standard deviation score (SDS) at baseline was -0.98 ±1.0 and weight SDS was -0.42 ±0.8. Patients were stratified according to virologic response (undetectable HIV RNA or not) or immunologic response (two-fold increase in absolute CD4 count or not) to PI's. Post-treatment (21.6 ±4.1 mo) anthropometric data in each group were compared to those in the immediate pre-treatment period (19.9 ±4.3 mo). After adding PI's to the ongoing ART, there was a slight increase in height velocity from -0.98 to -0.43 SD in the entire study population which was not statistically significant. There was no change in weight SDS (-0.42 to -0.43) for the entire group. Neither virologic (n=6) nor immunologic(n=7) responders grew better than non-responders in their corresponding groups. We found no correlation between viral load, CD4 cell count, and height velocity while on PI treatment. The growth response to PI therapy was also not different when patients were divided into 2 groups (n=7) based on initial pre-treatment height (best growers vs. worst growers). In general, in HIV-1-infected children, PI's decrease viral load and improve immunologic responses and weight gain. However, in our selected, mostly asymptomatic patient population. PI's had no significant effect on height velocity or weight SDS. Further studies of growth parameters are warranted in HIV-1-infected children with more advanced disease at the time of initiation of PI therapy.