title: Antiretroviral treatment for children.
abstract: 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.
authors.affiliation: Red Cross War Memorial Children's Hospital, Rondebosch, Cape Town, South Africa. beley@ich.uct.ac.za
authors.forename: Brian
authors.initials: B
authors.lastname: Eley
authors.forename: Mary-Ann
authors.initials: MA
authors.lastname: Davies
authors.forename: Patti
authors.initials: P
authors.lastname: Apolles
authors.forename: Carol
authors.initials: C
authors.lastname: Cowburn
authors.forename: Heloise
authors.initials: H
authors.lastname: Buys
authors.forename: Marco
authors.initials: M
authors.lastname: Zampoli
authors.forename: Heather
authors.initials: H
authors.lastname: Finlayson
authors.forename: Spasina
authors.initials: S
authors.lastname: King
authors.forename: James
authors.initials: J
authors.lastname: Nuttall
mesh_terms: 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
chemical_list: D044966:Anti-Retroviral Agents