title: Outcome of anti-retroviral treatment in HIV-infected orphans and non-orphans at an ART centre in North India.
abstract: BACKGROUND
  Few Indian studies have reported the long-term efficacy of anti-retroviral treatment (ART) in children and in orphaned, HIV-infected children in particular.
  
  
  OBJECTIVE
  To study differences in outcome of ART in HIV-infected orphans compared with non-orphans.
  
  
  METHODS
  A retrospective study of 87 HIV-infected children who commenced ART in the period January 2006 to August 2007. The main measures were orphan status, absolute CD4 count and weight-for-height (WHZ) and height-for-age (HAZ) Z-scores.
  
  
  RESULTS
  Median follow-up was 33 months. Forty  (45·9%) children were orphaned. Orphans and non-orphans had similar baseline median WHZ and HAZ (-2·48 vs -2·63, P = 0·65 and -2·78 vs -2·91, P = 0·77, respectively). The  two groups were similar in terms of WHO clinical stage and frequency of severe immunosuppression at presentation (P = 0·88 and 0·25, respectively). After ART initiation, the median absolute CD4 count increased progressively in both groups. Median WHZ and HAZ  increased throughout the study period in the orphans and reached -1 at 27 and 39 months of ART, respectively. In the non-orphans, WHZ remained below that of the orphan group, the difference becoming statistically significant from 18 months of ART. The increment in HAZ in the non-orphan  group was at par with the orphan group until 12 months of follow-up, after which it fell between 18 and 30 months. Subsequently, HAZ rose but remained below that of the orphan group. Both WHZ and HAZ failed to reach -1 in the non-orphan group. In both groups, 85% reported 100% adherence  to ART.
  
  
  CONCLUSIONS
  The outcome of ART is not affected by orphan status with the extended family adequately supporting orphaned children. Growth of children whose parents are HIV-infected may be constrained despite ART if there is inadequate family support.
authors.affiliation: Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India. drmalvikab@gmail.com
authors.forename: Malobika
authors.initials: M
authors.lastname: Bhattacharya
authors.forename: Romit
authors.initials: R
authors.lastname: Saxena
mesh_terms: D000293:Adolescent; D044966:Anti-Retroviral Agents / Q000008:administration & dosage*; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods*; D001835:Body Weight; D018791:CD4 Lymphocyte Count; D002648:Child; D054540:Child, Orphaned; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D007194:India; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D044966:Anti-Retroviral Agents