title: Antiretroviral therapy responses among children attending a large public clinic in Soweto, South Africa.
abstract: BACKGROUND
  Antiretroviral therapy (ART) access with successful outcomes for children is expanding in resource-limited countries. The aim of this study was to determine treatment responses of children in a routine setting where first-line therapy with lopinavir/ritonavir is routinely included for young children.
  
  
  METHODS
  Outpatient records of children who initiated ART between April 2004 and March 2008 at a government clinic in Soweto were reviewed. Children <3 years initiated ART with lopinavir/ritonavir and those ≥ 3 years initiated with efavirenz-containing regimens.
  
  
  RESULTS
  ART was initiated at a median age of 4.3 years, 28.6% also received tuberculosis treatment. During 3155 child-years of follow-up (median follow-up 17 months), 132 children (6%) died giving a mortality rate of 4.2 (95% confidence interval: 3.5, 5.0) deaths per 100 child-years. By 12 and 24 months, 84% and 96% of children achieved virologic suppression. The proportion of children with viral rebound increased from 5.4% to 16.3% at 24 and 36 months from start of ART. Younger children (receiving lopinavir/ritonavir-based first-line therapy) with higher viral loads suppressed more slowly and were more likely to die. Children who were started on treatment for tuberculosis at the time of viral suppression were more likely to have virologic rebound.
  
  
  CONCLUSIONS
  Despite good treatment outcomes overall, children with advanced disease at ART initiation had poorer outcomes, particularly those <3 years of age, most of whom were treated with lopinavir/ritonavir-containing therapy. The increasing risk of viral rebound over time for the whole cohort is concerning, given currently limited available treatment options for children.
authors: Department of Paediatrics, Harriet Shezi Children's Clinic, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. tammy@meyers.net
authors: Tammy M
authors: TM
authors: Meyers
authors: Marcel
authors: M
authors: Yotebieng
authors: Louise
authors: L
authors: Kuhn
authors: Harry
authors: H
authors: Moultrie
mesh_terms: D000480:Alkynes; D019380:Anti-HIV Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods / Q000401:mortality*; D048588:Benzoxazines / Q000008:administration & dosage / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D060085:Coinfection; D003521:Cyclopropanes; D005260:Female; D005500:Follow-Up Studies; D006678:HIV / Q000187:drug effects* / Q000502:physiology; D015658:HIV Infections / Q000188:drug therapy* / Q000401:mortality / Q000821:virology; D006779:Hospitals, Public; D006801:Humans; D007223:Infant; D061466:Lopinavir / Q000008:administration & dosage / Q000627:therapeutic use; D008297:Male; D009169:Mycobacterium tuberculosis / Q000187:drug effects / Q000502:physiology; D012008:Recurrence; D019438:Ritonavir / Q000008:administration & dosage / Q000627:therapeutic use; D013019:South Africa / Q000453:epidemiology; D016019:Survival Analysis; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy / Q000382:microbiology; D019562:Viral Load / Q000187:drug effects*
chemical_list: D000480:Alkynes; D019380:Anti-HIV Agents; D048588:Benzoxazines; D003521:Cyclopropanes; D061466:Lopinavir; C098320:efavirenz; D019438:Ritonavir