Antiretroviral therapy for HIV-1-infected children in Haiti.
BACKGROUND
Data are limited about the effectiveness of pediatric antiretroviral therapy (ART) in low-income countries.


METHODS
We report the outcomes of consecutively treating 236 human immunodeficiency virus type 1 (HIV-1)-infected treatment-naive children with triple ART in Port-au-Prince, Haiti, between 1 May 2003 and 30 April 2006.


RESULTS
Kaplan-Meier survival analysis at follow-up demonstrated that 191 children (81%) remained in care, 21 (9%) were dead, and 24 (10%) were lost to follow-up. Independent baseline predictors of mortality were age <18 months, CD4(+) T cell percentage < or =5%, and weight-for-age Z score (WAZ) less than -3. Twelve months into ART, 56% of tested subjects had undetectable HIV-1 RNA loads. Median CD4(+) T cell percentages at 12 months increased by 15%, 11%, and 5% in children with baseline percentages of < or =5%, 6%-24%, and > or =25%, respectively (P<.01). The median WAZ at 12 months increased by 1.0, 0.6, and 0.2 in children with baseline WAZ less than -2, -2 to -1.1, and -1 or more, respectively (P<.01).


CONCLUSIONS
With continuous donor support, trained providers, and the availability of pediatric antiretroviral drug formulations, it proved feasible to deliver pediatric ART in Haiti. The effectiveness of this program should encourage efforts to make ART available for HIV-infected children in poor countries.
George
Erik
E
Department of Medicine, Division of International Medicine and Infectious Diseases, Weill Medical College of Cornell University, New York, NY 10021, USA. erikgeorge@yepmail.net
Noël
Francine
F
Bois
Gyrlande
G
Cassagnol
Rachelle
R
Estavien
Louise
L
Rouzier
Patricia De Matteis
Pde M
Verdier
Rose I
RI
Johnson
Warren D
WD
Pape
Jean W
JW
Fitzgerald
Daniel W
DW
Wright
Peter F
PF
D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy* / Q000453:epidemiology / Q000401:mortality; D023241:Antiretroviral Therapy, Highly Active; D002648:Child; D005500:Follow-Up Studies; D015497:HIV-1; D006205:Haiti / Q000453:epidemiology; D006801:Humans; D011203:Poverty; D016019:Survival Analysis; D016896:Treatment Outcome; D019562:Viral Load