OBJECTIVE: To describe the response of children during their first year on highly active antiretroviral therapy (HAART). DESIGN: Retrospective, descriptive. SETTING: Tertiary, referral hospital. SUBJECTS: All HIV-infected children commenced on HAART from 1 August 2002 until 31 December 2004. OUTCOME MEASURES: Children were retrospectively restaged using the WHO 4-stage clinical classification and CDC immunological staging system. After commencing HAART, patients were assessed at monthly intervals for the first 6 months and thereafter mostly 3-monthly. Baseline and 6- monthly CD4 counts and viral loads were performed. RESULTS: Of 409 children commenced on HAART, 50.6% were < 2 years old, 62.7% had severe clinical disease and 76.6% had severe immune suppression. After 1 year, 65.8% were alive and continued HAART at the hospital, 11.2% had been transferred to another antiretroviral site, 15.4% had died, 4.6% were lost to follow-up and treatment had been discontinued in 2.9%. Kaplan-Meier survival estimate for 407 children at 1 year was 84% (95% confidence interval (CI) 80 - 87%). On multivariate analysis, survival was adversely affected in children with WHO stage 4 v. stage 2 and 3 disease (adjusted hazard ratio (HR): 5.26 (95% CI 2.25 - 12.32), p = 0.000), age < 12 months (adjusted HR: 2.46 (95% CI 1.48 - 4.09), p = 0.001) and CD4 absolute count (per 100 cell increase) (adjusted HR: 0.93 (95% CI 0.88 - 0.98), p = 0.013). In a separate multivariate model including only children with an initial viral load (N = 367), viral load > or = 1 million copies/ml (adjusted HR: 1.84 (95% CI 1.03 - 3.29)) and taking a protease inhibitor (PI)-based regimen (adjusted HR: 2.25 (95% CI 1.10 - 4.61)) were additionally independently associated with poorer survival; however, young age was not a significant predictor of mortality, after adjusting for viral load (p = 0.119). After 1 year of HAART 184/264 (69.7%) of children had a viral load < 400 copies/ml. Comparative analysis showed significant improvements in growth, immunological status and virological control. CONCLUSION: HAART can improve the health of many HIV-infected children with advanced disease, including those aged less than 2 years in resource-limited settings.
OBJECTIVE: To describe the response of children during their first year on highly active antiretroviral therapy (HAART). DESIGN: Retrospective, descriptive. SETTING: Tertiary, referral hospital. SUBJECTS: All HIV-infectedchildren commenced on HAART from 1 August 2002 until 31 December 2004. OUTCOME MEASURES: Children were retrospectively restaged using the WHO 4-stage clinical classification and CDC immunological staging system. After commencing HAART, patients were assessed at monthly intervals for the first 6 months and thereafter mostly 3-monthly. Baseline and 6- monthly CD4 counts and viral loads were performed. RESULTS: Of 409 children commenced on HAART, 50.6% were < 2 years old, 62.7% had severe clinical disease and 76.6% had severe immune suppression. After 1 year, 65.8% were alive and continued HAART at the hospital, 11.2% had been transferred to another antiretroviral site, 15.4% had died, 4.6% were lost to follow-up and treatment had been discontinued in 2.9%. Kaplan-Meier survival estimate for 407 children at 1 year was 84% (95% confidence interval (CI) 80 - 87%). On multivariate analysis, survival was adversely affected in children with WHO stage 4 v. stage 2 and 3 disease (adjusted hazard ratio (HR): 5.26 (95% CI 2.25 - 12.32), p = 0.000), age < 12 months (adjusted HR: 2.46 (95% CI 1.48 - 4.09), p = 0.001) and CD4 absolute count (per 100 cell increase) (adjusted HR: 0.93 (95% CI 0.88 - 0.98), p = 0.013). In a separate multivariate model including only children with an initial viral load (N = 367), viral load > or = 1 million copies/ml (adjusted HR: 1.84 (95% CI 1.03 - 3.29)) and taking a protease inhibitor (PI)-based regimen (adjusted HR: 2.25 (95% CI 1.10 - 4.61)) were additionally independently associated with poorer survival; however, young age was not a significant predictor of mortality, after adjusting for viral load (p = 0.119). After 1 year of HAART 184/264 (69.7%) of children had a viral load < 400 copies/ml. Comparative analysis showed significant improvements in growth, immunological status and virological control. CONCLUSION: HAART can improve the health of many HIV-infectedchildren with advanced disease, including those aged less than 2 years in resource-limited settings.
Authors: Boubacar Nacro; Emmanuelle Zoure; Hervé Hien; Hassane Tamboura; François Rouet; Adama Ouiminga; Ali Drabo; Souleymane Yameogo; Alain Hien; Hélène Peyriere; Olivier Mathieu; Deborah Hirt; Jean-Marc Treluyer; Joëlle Nicolas; Vincent Foulongne; Michel Segondy; Philippe van de Perre; Serge Diagbouga; Philippe Msellati Journal: Bull World Health Organ Date: 2011-04-06 Impact factor: 9.408
Authors: Ramadhani S Mwiru; Donna Spiegelman; Christopher Duggan; George R Seage; Helen Semu; Guerino Chalamilla; Rodrick Kisenge; Wafaie W Fawzi Journal: J Trop Pediatr Date: 2014-01-06 Impact factor: 1.165