Comprehensive pediatric human immunodeficiency virus care and treatment in Constanta, Romania: implementation of a program of highly active antiretroviral therapy in a resource-poor setting.
BACKGROUND
Relatively few human immunodeficiency virus (HIV)-infected children worldwide have access to care and treatment. The Romanian-American Children's Center, a collaborative project of a U.S. health care institution and the Romanian government, has established a comprehensive program of highly active antiretroviral therapy for children in Constanta, Romania.


OBJECTIVE
To describe the design and outcomes of a program of pediatric HIV/acquired immunodeficiency syndrome (AIDS) care and treatment in a resource-poor setting.


METHODS
Outpatient center providing comprehensive primary and HIV/AIDS specialty care and treatment to all known HIV-infected children living in Constanta County, Romania.


RESULTS
As of August 2003, a total of 452 children were receiving highly active antiretroviral therapy. Therapy has been well-tolerated, with approximately 90% of children continuing to receive treatment after a median duration of follow-up of 67 weeks. Normal weight and height growth velocities have been observed among treated children. Marked decreases have been observed in rates of hospitalization and mortality. The mean change in CD4+ lymphocyte count for 173 children who have both a baseline count and at least 1 follow-up count is +284 cells/microL (P < 0.0001).


CONCLUSIONS
Highly active antiretroviral therapy can be administered safely and effectively to children in a resource-poor setting, with outcomes comparable with those observed in U.S. pediatric antiretroviral clinical trials.
Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX 77030, USA. mkline@texaschildrenshospital.org
Mark W
MW
Kline
Rodica F
RF
Matusa
Letitia
L
Copaciu
Nancy R
NR
Calles
Nancy E
NE
Kline
Heidi L
HL
Schwarzwald
D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy* / Q000191:economics; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D002648:Child; D002657:Child Development; D003153:Community Health Services / Q000706:statistics & numerical data*; D003695:Delivery of Health Care / Q000458:organization & administration*; D003906:Developing Countries; D005260:Female; D006301:Health Services Needs and Demand; D006801:Humans; D008297:Male; D008511:Medicine; D017063:Outcome Assessment, Health Care; D010045:Outpatients; D011320:Primary Health Care; D016730:Program Development; D012383:Romania; D013038:Specialization; D016896:Treatment Outcome