Paediatric antiretroviral therapy outcomes under HIV hospice care in South Africa.
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.
Harding
Richard
R
King's College London, Department of Palliative Care, Policy and Rehabilitation, United Kingdom. richard.harding@kcl.ac.uk
Brits
Hanneke
H
Penfold
Suzanne
S
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
D019380:Anti-HIV Agents