title: In resource-limited settings good early outcomes can be achieved in children using adult fixed-dose combination antiretroviral therapy.
abstract: OBJECTIVE
  To (a) determine early treatment outcomes and (b) assess safety in children treated with adult fixed-dose combination (FDC) antiretroviral tablets.
  
  
  METHODS
  Sixteen Medecins Sans Frontieres (MSF) HIV programs in eight countries in resource-limited settings (RLS).
  
  
  METHODS
  Analysis of routine program data gathered June 2001 to March 2005.
  
  
  RESULTS
  A total of 1184 children [median age, 7 years; inter-quartile range (IQR), 4.6-9.3] were treated with antiretroviral therapy (ART) of whom 616(52%) were male. At ART initiation, Centres for Disease Control stages N, A, B and C were 9, 14, 38 and 39%, respectively. Children were followed up for a median period of 6 months (IQR, 2-12 months). At 12 months the median CD4 percentage gain in children aged 18-59 months was 15% (IQR, 6-18%), and the percentage with CD4 gain < 15% was reduced from 85% at baseline to 11%. In those aged 60-156 months, median CD4 cell count gain was 275 cells/microl (IQR, 84-518 cells/microl), and the percentage with CD4 < 200 cells/mul reduced from 51% at baseline to 11%. Treatment outcomes included; 1012 (85%) alive and on ART, 36 (3%) deaths, 15 (1%) stopped ART, 89 (8%) lost to follow-up, and 31 (3%) with unknown outcomes. Overall probability of survival at 12 months was 0.87 (0.84-0.89). Side effects caused a change to alternative antiretroviral drugs in 26 (2%) but no deaths.
  
  
  CONCLUSIONS
  Very satisfactory early outcomes can be achieved in children in RLS using generic adult FDC antiretroviral tablets. These findings strongly favour their use as an "interim solution" for scaling-up ART in children; however, more appropriate pediatric antiretroviral drugs remain urgently needed.
authors.affiliation: AIDS Working Group, Medecins Sans Frontieres, Plantage Middenlaan 14, 1001 EA Amsterdam, The Netherlands. daniel.obrien@amsterdam.msf.org
authors.forename: Daniel P
authors.initials: DP
authors.lastname: O'Brien
authors.forename: Delphine
authors.initials: D
authors.lastname: Sauvageot
authors.forename: Rony
authors.initials: R
authors.lastname: Zachariah
authors.forename: Pierre
authors.initials: P
authors.lastname: Humblet
mesh_terms: D000349:Africa; D044966:Anti-Retroviral Agents / Q000008:administration & dosage* / Q000191:economics / Q000627:therapeutic use; D001210:Asia, Southeastern; D018791:CD4 Lymphocyte Count; D002648:Child; D002675:Child, Preschool; D003906:Developing Countries; D004334:Drug Administration Schedule; D016527:Drug Costs; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology / Q000401:mortality; D006801:Humans; D008297:Male; D012449:Safety; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D044966:Anti-Retroviral Agents