title: Treatment outcomes among HIV-1 and HIV-2 infected children initiating antiretroviral therapy in a concentrated low prevalence setting in West Africa.
abstract: BACKGROUND
  There is little data on responses to combination antiretroviral therapy (cART) among HIV-infected children in the West African region. We describe treatment outcomes among HIV-1 and HIV-2 infected children initiating cART in a research clinic in The Gambia, West Africa.
  
  
  METHODS
  All treatment naive HIV-infected children who initiated cART according to the WHO ART guidelines for children between October 2004 and December 2009 were included in the analysis. Kaplan-Meir estimates and sign-rank test were used to investigate the responses to treatment.
  
  
  RESULTS
  65 HIV-1 and five HIV-2 infected children aged < 15 years were initiated on cART over this time period. HIV-1 infected children were treated with a combination of Zidovudine or Stavudine + Lamivudine + Nevirapine or Efavirenz while children with HIV-2 were treated with Zidovudine + Lamivudine + ritonavir-boosted Lopinavir. HIV-1 infected children were followed-up for a median (IQR) duration of 20.1 months (6.9 - 34.3), with their median (IQR) age at treatment initiation, CD4% and plasma viral load at baseline found to be 4.9 years (2.1 - 9.1), 13.0% (7.0 - 16.0) and 5.4 log10 copies/ml (4.4 - 6.0) respectively. The median age at treatment initiation of the five HIV-2 infected children was 12 years (range: 4.6 - 14.0) while their median baseline CD4+ T cell count and HIV-2 viral load were 140 cells/mm3 (Range: 40 - 570 cells/mm3) and 4.5 log10copies/mL (Range: 3.1 - 4.9 log10copies/mL) respectively.Among HIV-1 infected children <5 years of age at ART initiation, the median (IQR) increases in CD4% from baseline to 12, 24 and 36 months were 14% (8 - 19; P = 0.0004), 21% (15 - 22; P = 0.005) and 15% (15 - 25; P = 0.0422) respectively, while the median (IQR) increase in absolute CD4 T cell count from baseline to 12, 24 and 36 months for those ≥5 years at ART initiation were 470 cells/mm3 (270 - 650; P = 0.0005), 230 cells/mm3 (30 - 610; P = 0.0196) and 615 cells/mm3 (250 - 1060; P = 0.0180) respectively. The proportions of children achieving undetectable HIV-1 viral load at 6-, 12-, 24- and 36 months of treatment were 24/38 (63.2%), 20/36 (55.6%), 8/22 (36.4%) and 7/12 (58.3%) respectively. The probability of survival among HIV-1 infected children after 12 months on ART was 89.9% (95% CI 78.8 - 95.3). CD4 T cell recovery was sub-optimal in all the HIV-2 infected children and none achieved virologic suppression. Two of the HIV-2 infected children died within 6 months of starting treatment while the remaining three were lost to follow-up.
  
  
  CONCLUSIONS
  The beneficial effects of cART among HIV-1 infected children in our setting are sustained in the first 24 months of treatment with a significant improvement in survival experience up to 36 months; however the outcome was poor in the few HIV-2 infected children initiated on cART.
authors: Medical Research Council (UK) Laboratories, Fajara, Banjul, The Gambia. uokomo@mrc.gm
authors: Uduak
authors: U
authors: Okomo
authors: Toyin
authors: T
authors: Togun
authors: Francis
authors: F
authors: Oko
authors: Kevin
authors: K
authors: Peterson
authors: John
authors: J
authors: Townend
authors: Ingrid
authors: I
authors: Peterson
authors: Assan
authors: A
authors: Jaye
mesh_terms: D000293:Adolescent; D000480:Alkynes; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D048588:Benzoxazines / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003521:Cyclopropanes; D004338:Drug Combinations; D005260:Female; D005500:Follow-Up Studies; D005714:Gambia; D015658:HIV Infections / Q000188:drug therapy* / Q000401:mortality / Q000821:virology; D015497:HIV-1; D015498:HIV-2; D006801:Humans; D007223:Infant; D053208:Kaplan-Meier Estimate; D019259:Lamivudine / Q000627:therapeutic use; D061466:Lopinavir / Q000627:therapeutic use; D008297:Male; D019829:Nevirapine / Q000627:therapeutic use; D018894:Reverse Transcriptase Inhibitors / Q000627:therapeutic use*; D019438:Ritonavir / Q000627:therapeutic use; D016896:Treatment Outcome; D019562:Viral Load / Q000706:statistics & numerical data; D015215:Zidovudine / Q000627:therapeutic use
chemical_list: D000480:Alkynes; D019380:Anti-HIV Agents; D048588:Benzoxazines; D003521:Cyclopropanes; D004338:Drug Combinations; D018894:Reverse Transcriptase Inhibitors; C558899:lopinavir-ritonavir drug combination; D061466:Lopinavir; D019259:Lamivudine; D015215:Zidovudine; D019829:Nevirapine; C098320:efavirenz; D019438:Ritonavir