Experience of anti-retroviral treatment for HIV-infected children in Malawi: the 1st 12 months.
BACKGROUND
Malawi is a resource-poor country in central southern Africa with an estimated 91,000 HIV-infected children. A national public sector antiretroviral treatment (ART) scale-up programme was commenced in 2004.


OBJECTIVE
The experience and results of the 1st 12 months of free ART for HIV-infected children from a public sector hospital in Malawi is reported.


METHODS
Demographic and clinical data were collected at the commencement of ART and during treatment of all children who attended the clinic at Queen Elizabeth Central Hospital, Blantyre from 1 August 2004 to 31 July 2005.


RESULTS
ART was prescribed for 238 children during the 1st 12-month period. Of these, 196 were ART-naïve and 42 had previously begun ART elsewhere. There were 128 (53.8%) males. Median age of the 196 ART-naïve children was 87 months (range 7-212); 173 (88.3%) had WHO clinical stage III disease and 23 (11.7%) had WHO clinical stage I or II disease. Weight-for-age and weight-for-height Z-scores improved significantly with treatment. By 31 July 2005, 194 (81.5%) of the 238 children who attended the clinic were alive and on treatment, 20 (8.4%) had died, 19 (8.0%) were lost to follow-up and 5 (2.1%) had been transferred to other health facilities.


CONCLUSIONS
In a resource-poor setting with only clinical monitoring available, children can feasibly and effectively be treated with ART. Lack of appropriate laboratory facilities, extra staff and paediatric drug formulations, although not ideal, should not prevent commencement of ART for children in such a setting.
Department of Paediatrics, College of Medicine, University of Malawi, Blantyre, Malawi. jane.ellis@nuh.nhs.uk
Jane
J
Ellis
Elizabeth M
EM
Molyneux
D000293:Adolescent; D000886:Anthropometry; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods; D002648:Child; D002675:Child, Preschool; D003906:Developing Countries; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D007223:Infant; D008295:Malawi; D008297:Male; D017150:Public Sector; D016896:Treatment Outcome
D019380:Anti-HIV Agents