Successful paediatric HIV treatment in rural primary care in Africa.
OBJECTIVE
Clinical outcomes of HIV-infected children on antiretroviral treatment (ART) in a decentralised, nurse/counsellor-led programme.


METHODS
Clinical cohort.


METHODS
KwaZulu-Natal, South Africa.


METHODS
HIV-infected children aged <or=15 years on ART, June 2004-2008.


METHODS
Survival according to baseline characteristics including age, WHO clinical stage, haemoglobin and CD4%, was assessed in Kaplan-Meier analyses. Hazard ratios for mortality were estimated using Cox proportional hazards regression and changes in laboratory parameters and weight-for-age z scores after 6-12 months' treatment were calculated.


RESULTS
477 HIV-infected children began ART at a median age of 74 months (range 4-180), median CD4 count (CD4%) of 433 cells/mm(3) (17%) and median HIV viral load of log 4.2 copies/ml; 105 (22%) were on treatment for tuberculosis and 317 (76.6%) were WHO stage 3/4. There were significant increases after ART initiation in CD4% (17% vs 22%; p<0.001), haemoglobin (9.9 vs 11.7 g/l; p<or=0.001) and albumin (30 vs 36 g/l; p<or=0.001). 32 (6.7%) children died over 732 child-years of follow-up (43.7 deaths/1000 child-years; 95% CI 32.7 to 58.2), 17 (53.1%) within 90 days of treatment initiation; median age of death was 84 (IQR 10-181) months. Children with baseline haemoglobin <or=8 g/l were more likely to die (adjusted HR 4.5; 95% CI 1.6 to 12.3), as were those aged <18 months compared with >60 months (adjusted HR 3.2; 95% CI 1.2 to 9.1).


CONCLUSIONS
Good clinical outcomes in HIV-infected children on ART are possible in a rural, decentralised service. Few young children are on ART, highlighting the urgent need to identify HIV-exposed infants.
Janssen
N
N
Africa Centre for Health and Population Studies, University of KwaZulu-Natal, KwaZulu-Natal, South Africa.
Ndirangu
J
J
Newell
M-L
ML
Bland
R M
RM
D000293:Adolescent; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D002648:Child; D002675:Child, Preschool; D004812:Epidemiologic Methods; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology / Q000821:virology; D015497:HIV-1 / Q000302:isolation & purification*; D006801:Humans; D007223:Infant; D008297:Male; D011320:Primary Health Care / Q000458:organization & administration*; D015397:Program Evaluation; D019035:Rural Health Services / Q000458:organization & administration*; D013019:South Africa; D016896:Treatment Outcome; D019562:Viral Load
D019380:Anti-HIV Agents