title: Paediatric antiretroviral therapy outcomes under HIV hospice care in South Africa.
abstract: OBJECTIVE
  This study aims to evaluate outcomes of children with advanced HIV disease who are initiated on antiretroviral therapy under multiprofessional specialist paediatric hospice care.
  
  
  METHODS
  A retrospective cohort file review methodology was undertaken in a specialist paediatric hospice in South Africa.
  
  
  METHODS
  Antiretroviral therapy was initiated for children with a CD4% of less than 15% (for children under 6 years of age) or a CD4 count under 200 for children over 6 years of age. According to the World Health Organization Europe (2007) staging criteria, all children were stage 3/4 HIV disease. Multiprofessional staff provided daily tailored assessment and care. Each child was followed for 6 months. Data on mortality, CD4 count, CD4 percentage, body weight, and viral load were measured at initiation and a follow-up after 6 months.
  
  
  RESULTS
  Of the 37 children initiated on ART therapy, 31 I survived at 6 months. From a baseline of mean body weight 13.3 kg, there was an average of 3.2 kg increase (P < 0.001). Mean CD4 counts more than doubled (P < 0.001), with a mean increase of 467 cells per mm3 blood. Mean CD4 percentages increased from 13.6-19.4% (P < 0.001).Viral load decreased significantly from a median 271000 copies per mm3 blood to a median of 25 (imputed value for undetectable viral load) (P < 0.001). Twenty-three children had an undetectable viral load.
  
  
  CONCLUSIONS
  For children with advanced HIV disease, who are least likely to access or respond to treatment, this study demonstrates a novel approach to managing care successfully.
authors.affiliation: King's College London, Department of Palliative Care, Policy and Rehabilitation, United Kingdom. richard.harding@kcl.ac.uk
authors.forename: Richard
authors.initials: R
authors.lastname: Harding
authors.forename: Hanneke
authors.initials: H
authors.lastname: Brits
authors.forename: Suzanne
authors.initials: S
authors.lastname: Penfold
mesh_terms: D019380:Anti-HIV Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006738:Hospices; D006801:Humans; D007223:Infant; D008297:Male; D010166:Palliative Care; D018579:Patient Selection; D012189:Retrospective Studies; D013019:South Africa; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D019380:Anti-HIV Agents