title: The 10-year effectiveness of combination antiretroviral treatment in perinatally HIV-infected children participating in Thailand's National Access Program.
abstract: The National Access to Antiretroviral Program for People Living with HIV/AIDS was launched in Thailand in 2002. HIV-infected, antiretroviral-naive, severely immunosuppressed children were initiated on highly active combination antiretroviral treatment (cART). This study aimed to determine the long-term effectiveness of cART.
  
  
  
  Data were extracted from medical records. Primary end points were mortality rate, proportion of children who remained on first-line cART regimen and children with plasma HIV RNA level (pVL) <50 copies/ml at week 520.
  
  
  
  From August 2002 to July 2003, 107 children were enrolled. The baseline median age was 7.6 years (IQR 5.7-10.0), the median CD4(+) T-cell count was 60 cells/mm(3) (IQR 21-272) and the median pVL was 5.37 log10 copies/ml (IQR 5.01-5.76). The mortality rate during and after the first year was 3.7 and 0.006 deaths/100 person-years, respectively. At week 520, 90 (84%) continued to be actively followed. Their median age was 17.8 years (IQR 15.8-19.8). 73 (81% as-treated) remained on the first-line regimen, while 18 (20%) had switched to a second-line cART regimen, at the median time of 272 weeks (IQR 256-363) after the first-line cART initiation. 69 (77%) had pVL<50 copies/ml and the median CD4(+) T-cell count was 636 cells/mm(3) (IQR 466-804). 83 (92%) and 64 (71%) had CD4(+) T-cell counts ≥200 and >500 cells/mm(3), respectively.
  
  
  
  Long-term virological control, favourable immunological outcomes and healthy survival was achieved in severely immunosuppressed, perinatally HIV-infected children who started first-line NNRTI-based cART. Continuing surveillance for long-term complications is warranted.
authors.affiliation: Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand. lindaa@rihes.org.
authors.forename: Linda
authors.initials: L
authors.lastname: Aurpibul
authors.forename: Thanyawee
authors.initials: T
authors.lastname: Puthanakit
authors.forename: Tavitiya
authors.initials: T
authors.lastname: Sudjaritruk
authors.forename: Peninnah
authors.initials: P
authors.lastname: Oberdorfer
authors.forename: Tawalchaya
authors.initials: T
authors.lastname: Chotecharoentanan
authors.forename: Sineenart
authors.initials: S
authors.lastname: Taejaroenkul
authors.forename: Nongyow
authors.initials: N
authors.lastname: Wongnum
authors.forename: Virat
authors.initials: V
authors.lastname: Sirisanthana
mesh_terms: D000293:Adolescent; D019380:Anti-HIV Agents / Q000008:administration & dosage* / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D002648:Child; D002675:Child, Preschool; D004359:Drug Therapy, Combination; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology* / Q000401:mortality; D006297:Health Services Accessibility; D006801:Humans; D018445:Infectious Disease Transmission, Vertical; D008137:Longitudinal Studies; D008297:Male; D009313:National Health Programs; D013785:Thailand / Q000453:epidemiology; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents