Antiretroviral treatment for children.
OBJECTIVE
To describe the response of children during their first year on highly active antiretroviral therapy (HAART).


METHODS
Retrospective, descriptive.


METHODS
Tertiary, referral hospital.


METHODS
All HIV-infected children commenced on HAART from 1 August 2002 until 31 December 2004.


METHODS
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.


CONCLUSIONS
HAART can improve the health of many HIV-infected children with advanced disease, including those aged less than 2 years in resource-limited settings.
Eley
Brian
B
Red Cross War Memorial Children's Hospital, Rondebosch, Cape Town, South Africa. beley@ich.uct.ac.za
Davies
Mary-Ann
MA
Apolles
Patti
P
Cowburn
Carol
C
Buys
Heloise
H
Zampoli
Marco
M
Finlayson
Heather
H
King
Spasina
S
Nuttall
James
J
D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods; D018791:CD4 Lymphocyte Count; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006678:HIV; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology / Q000821:virology; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome; D019562:Viral Load
D044966:Anti-Retroviral Agents