Initial experience of a public sector antiretroviral treatment programme for HIV-infected children and their infected parents.
OBJECTIVE
To describe the initial experience of treating HIV-infected children and their infected parents with antiretroviral therapy.


METHODS
Prospective, cohort study.


METHODS
Tertiary, referral hospital.


METHODS
HIV-infected children and their parents.


METHODS
This report focuses on the early response of children to highly active antiretroviral therapy (HAART). Children were followed up at 4-weekly intervals. Monitoring included initial and yearly viral load measurements, baseline and 6-monthly CD4 counts and 4-weekly adherence checks.


RESULTS
Between August 2002 and June 2003, 80 children were enrolled in the programme, representing a follow-up period of 23.9 patient-years. Seventy-five children had severe clinical disease, severe immune suppression, or a combination of the two. The response of children who had received HAART for > or = 6 months (N = 17) was assessed. There was no change in mass z-score (p = 0.11) or length z-score (p = 0.37), but a significant increase in CD4 percentage (p < 0.0001) during the first 6 months of therapy. Six-month viral loads were available for 12 children. There was a significant drop in viral load (p = 0.001) and 9 achieved undetectable levels by 6 months. Most children achieved > or = 85% adherence. By June 2002, 67 children (84%) were relatively well, 1 had B-cell lymphoma, 7 (8.8%) had died, 4 (5%) were lost to follow-up and 1 was withdrawn from the programme. Of 57 children who completed 3 months of HAART, 12 were admitted a total of 17 times for infectious complications. There were no severe drug reactions. Three of 7 mothers on HAART received treatment through the programme.


CONCLUSIONS
These initial results suggest that many HIV-infected children in the public sector will benefit from antiretroviral therapy. However, both ambulatory and inpatient facilities are required to manage children on HAART comprehensively.
Eley
Brian
B
Department of Paediatrics and Child Health, Red Cross Children's Hospital and University of Cape Town.
Nuttall
James
J
Davies
Mary-Ann
MA
Smith
Lara
L
Cowburn
Carol
C
Buys
Heloise
H
Hussey
Gregory
G
D000328:Adult; D000367:Age Factors; D019380:Anti-HIV Agents / Q000008:administration & dosage*; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods*; D002675:Child, Preschool; D015331:Cohort Studies; D003906:Developing Countries; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D015658:HIV Infections / Q000151:congenital / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D007223:Infant; D008297:Male; D010349:Patient Compliance; D011336:Probability; D011446:Prospective Studies; D017150:Public Sector; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D013019:South Africa; D018709:Statistics, Nonparametric; D015996:Survival Rate; D016896:Treatment Outcome
D019380:Anti-HIV Agents