PONE-D-21-23594BODY COMPOSITION, PHYSICAL FITNESS AND PHYSICAL ACTIVITY IN MOZAMBICAN CHILDREN AND ADOLESCENTS WITH HIVPLOS ONE

Dear Dr. Chirindza,

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PLOS ONE

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Partly

Reviewer #3: Yes

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: No

Reviewer #3: Yes

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3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: General comment: The present study has a relevant theme and based on the findings of this study, health promotion actions can be better designed for children and adolescents with HIV.

Comment: In general the introduction is well written. Only at the end, the authors could add how the investigation of this information could help health professionals.

Comment: In the methodology, I suggest to the authors the inclusion of the sample size calculation, even if it is performed a posteriori.

Comment: In the methodology explain better how the children and adolescents who took part in the study were recruited.

Comment: In the statistical analysis, shouldn't sex be considered as an adjustment in ANCOVA?

Comment: When comparing variables between boys and girls, enter the P values showing whether there are significant differences.

“Most of the studies in the literature reveal identical results. Dos Santos [44] evaluated 63 Brazilian children and adolescents and found that both abdominal muscle strength and flexibility presented values below the cutoff point in both sexes. Barros et al. [49] studied the muscular strength of 33 Brazilian children of both sexes, aged between 7 and 12 years, all with HIV on ART, and observed that the scores in the neuromotor tests were below the normal range, as well as in relation to the group of children who did not have the virus, even when compared by sex, wich agree with the results of the present study.”

Comment: What would be the reasons? The authors seek to discuss the possible mechanisms.

“In a cross-sectional study Martins et al. [37] done with a sample of 57 Brazilian adolescents of both sexes between 10 and 15 years, with HIV and a control group of the same size and age and sexual level, using the physical activity questionnaire (PAQ-C). It was observed that adolescents with HIV had lower scores of physical activity when compared to their peers considered healthy.”

Comment: Why does this happen? What are the possible differences?

Comment: In the discussion, the authors make a series of important comparisons, but there is still a need to better discuss the reason for the differences or similarities of these comparisons.

Comment: A limitation that must be considered is the fact that the sample was by convenience (which does not diminish the importance of the study).

Comment: After the limitation paragraph, insert the study's strengths paragraph.

Comment: What are the practical applications of this study. How can this information help health professionals who care for children and adolescents with HIV?

Reviewer #2: The authors presented an interesting study about body composition and physical activity in Mozambican children and adolescents.

Although the article is well written and shows interesting conclusions, it fails to provide innovations. Per the authors admission, "This finding seems to be common to many studies, which state that children and adolescents

living with HIV tend to be smaller, have lower body weight and enter puberty later compared

to their apparently healthy peers".

Moreover, we found some serious problems the authors should address:

1) METHODS

a) "The ART regimen in use and the viral load were not taken into account for this study"

We find that this choice is problematic and limits the validity of the results of the study for several reasons. First of all, it is known that different drugs have different effects on metabolism, and especially lipid metabolism. Moreover, a persistent high level of plasma viral load leads to poor growth rates, due to persisting inflammation. In addition, low level viremia has been also related to persisting high levels of inflammation.

Therefore, we find that not considering actual ART regimen, past ART regimens (if any), time spent on ART regiment (present and past), and pVL makes the results of this study unreliable and non-reproducible.

2) RESULTS

a) "Descriptive results (n, mean +/- sd)"

Were the quantitative variables normally distributed? If not, "median (IQR)" should be used to summarize the variables.

Reviewer #3: Comments to the authors

PONE-D-21-23594

Title of the paper: Body composition, physical fitness and physical activity in children and adolescents with HIV.

The author(s) presented an interesting cross-sectional data on “Body composition, physical fitness and physical activity in children and adolescents with HIV from Mozambique”. There are some minor points which have to be considered in the manuscript.

Generally, the authors stated that ‘the adolescents and children with’; and this sounds not good and need to rephrased to include the word ‘living’ with, and this need to be addressed throughout the manuscript.

Title: The title is missing the inclusion of the word ‘living’ between the words ‘…adolescents .. and … with ..’. so that it reads as ‘Body composition, physical fitness and physical activity in children and adolescents living with HIV’.

Abstract: In the background and methods section first sentence, the authors are advised to reconsider the inclusion of the word ‘living’ as per comments above. In the second sentence the authors wrote a prefix for physical in capital letter and it is inconsistent with others, a clarification will be helpful.

The first conclusion sentence need to be rephrased, and it can be rephrased as ‘The subjects participants in the study living with HIV and undergoing ART had impaired growth………….’

Introduction

Can the authors clarify why the prefix for ‘development’ the sentence reading as ‘The Development of children…..’ written in capital letter.

In strengthening the arguments in the second paragraph of the introduction it would have been good if the authors could have considered a systematic review and meta-analysis by Rafaela Catherine da Silva Cunha de Medeiros and colleagues as published in 2021.

Methods

Can the authors clarify the how the contacts were done in the statement ‘Subjects were selected by contacts made with those who attended specific health care centers for children and adolescents with HIV in Maputo’ consideration the issues of stigmatisation amongst and ethical issues. It will helpful for the paper if the author could give a full description of the care centers settings in Mozambique. Also, the authors should provide the ethical approval number of the study given the vulnerability of the subjects participants in the study.

Under statistical analysis, sentence reading as ‘the proportion……’; an inconsistency has been observed in terms of the writing of sentences. As such corrections is required.

Spelling mistake for the word ‘same’ in the sentence reading as ‘To compare with non-HIV ± Mozambican peers of the some age and gender…..’. The authors are advised to make corrections.

Results

In table 1 and its text the authors for the first time are presented the distributions of the participants according to urban and rural settings of which such description is not explicit in the description of the participants in the methods. The authors should provide the description of their subjects participants in the methods section.

As indicated in Table 4 that it is about comparison of the HIV± and HIV-; can the authors clarify the distribution of this groups from their 79 included participants because it is unclear. Such clarification will helpful in understanding the subsequent analysis.

Discussion

In line with the comments regarding comparison between HIV± and HIV-, the major findings outlined in the first paragraph remain sketchy until a clarification is made about the distribution of the participants in accordance with this distribution.

Second paragraph, the name of the country Mozambique is written in small letter, as such corrections is needed.

Page 18, sentence reading as ‘This was consistent with few exception’. What are those exceptions, because this sentence seems lacking supporting statements. Clarification is required.

Under the subheading ‘Physical fitness’; 2nd paragraph sentence reading as ‘…..compared by sex, wich agree with the results of the present study.’ There is a spelling mistake for the word ‘which’; and corrections is needed.

The described limitations are without a proper link with the results and how they affected the current findings. As such, a more concise clarification regarding the limitations is required.

References

Generally, there are inconsistence references whereby some date are written in brackets (i.e. Ref numbers; 7;28;48; 55) and others not or just after the authors; and or at the end of the journal name.

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Reviewer #1: No

Reviewer #2: No

Reviewer #3: No

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BODY COMPOSITION, PHYSICAL FITNESS AND PHYSICAL ACTIVITY IN MOZAMBICAN CHILDREN AND ADOLESCENTS LIVING WITH HIV

PONE-D-21-23594R1

Dear Dr. Chirindza,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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Kind regards,

Diego Augusto Santos Silva, Ph.D.

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

Reviewer #3: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #3: Yes

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3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #3: Yes

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4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #3: Yes

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5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #3: Yes

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6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: The authors responded point by point to all my comments, as well as added the suggestions in the text. So I have no further comments to make.

Reviewer #3: I am satisfied with the revised manuscript as the authors addressed all the comments which was raised from the initial review.

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: Yes: Diego G.D. Christofaro- São Paulo State University (UNESP)

Reviewer #3: No

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