title: HIV-infected children in the Asia-Pacific region with baseline severe anemia: antiretroviral therapy and outcomes.
abstract: BACKGROUND
  Severe anemia is common among children infected with human immunodeficiency virus (HIV). The choice of antiretroviral (ART) regimen needs careful consideration. No information is available regarding the initial ART regimens used in the Asia-Pacific region and the rate of switch of ART regimens in HIV-infected children with severe anemia.
  
  
  OBJECTIVE
  To study the initial ART regimens and the rate of switch of ART regimens used during the first 36 months in HIV-infected children with severe anemia and to evaluate their clinical and laboratory outcomes.
  
  
  METHODS
  We analyzed regional cohort data of 130 Asian children aged <18 years with baseline severe anemia (hemoglobin <7.5 g/dl) who started antiretroviral therapy (ART) between January 2003 and September 2013.
  
  
  RESULTS
  At ART initiation, median age was 3.5 years old (interquartile range (IQR) 1.7 to 6.3) and median hemoglobin was 6.7 g/dL (IQR 5.9-7.1, range 3.0-7.4). Initial ART regimens included stavudine (85.4%), zidovudine (13.8%), and abacavir (0.8%). In 81 children with available hemoglobin data after 6 months of ART, 90% recovered from severe anemia with a median hemoglobin of 10.7 g/dL (IQR 9.6-11.7, range 4.4-13.5). Those starting AZT-based ART had a mortality rate of 10.8 (95% confidence interval (CI) 4.8-23.9) per 100 patient-years compared to 2.7 (95% CI 1.6-4.6) per 100 patient-years among those who started d4T-based ART.
  
  
  CONCLUSIONS
  With the phase-out of stavudine, age-appropriate non-zidovudine options are needed for younger Asian children with severe anemia.
authors.affiliation: Division of Infectious Diseases, Department of Pediatrics, Khon Kaen University, Khon Kaen 40002, Thailand.
authors.forename: Pagakrong
authors.initials: P
authors.lastname: Lumbiganon
authors.affiliation: Division of Infectious Diseases, Department of Pediatrics, Khon Kaen University, Khon Kaen 40002, Thailand.
authors.forename: Pope
authors.initials: P
authors.lastname: Kosalaraksa
authors.affiliation: HIV-NAT, the Thai Red Cross AIDS Research Centre, Bangkok 10330, Thailand.
authors.forename: Torsak
authors.initials: T
authors.lastname: Bunupuradah
authors.affiliation: The Kirby Institute, University of New South Wales, Sydney, NSW 2052, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Boettiger
authors.affiliation: National Centre for HIV/AIDS, Dermatology and STDs (NCHADS), Phnom Penh, Cambodia.
authors.forename: Vonthanak
authors.initials: V
authors.lastname: Saphonn
authors.affiliation: Children's Hospital 1, Ho Chi Minh City, Vietnam.
authors.forename: Khanh H
authors.initials: KH
authors.lastname: Truong
authors.affiliation: Cipto Mangunkusumo General Hospital, Jakarta, Indonesia.
authors.forename: Nia
authors.initials: N
authors.lastname: Kurniati
authors.affiliation: Chiangrai Prachanukroh Hospital, Chiang Rai 57000, Thailand.
authors.forename: Rawiwan
authors.initials: R
authors.lastname: Hansudewechakul
authors.affiliation: Children's Hospital 2, Ho Chi Minh City, Vietnam.
authors.forename: Viet C
authors.initials: VC
authors.lastname: Do
authors.affiliation: Department of Pediatrics, Faculty of Medicine, Chiang Mai University and Research Institute for Health Sciences, Chiang Mai 50200, Thailand.
authors.forename: Tavitiya
authors.initials: T
authors.lastname: Sudjaritruk
authors.affiliation: YRG CARE Medical Centre, CART CRS, Chennai, India.
authors.forename: Nagalingeswaran
authors.initials: N
authors.lastname: Kumarasamy
authors.affiliation: Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.
authors.forename: Nantakar
authors.initials: N
authors.lastname: Kongstan
authors.affiliation: Hospital Raja Perempuan Zainab II, Kelantan 15000, Malaysia.
authors.forename: Nik K N
authors.initials: NK
authors.lastname: Yusoff
authors.affiliation: National Hospital of Pediatrics, Hanoi, Vietnam.
authors.forename: Lam V
authors.initials: LV
authors.lastname: Nguyen
authors.affiliation: Sanglah Hospital, Udayana University, Bali, Indonesia.
authors.forename: Dewi K
authors.initials: DK
authors.lastname: Wati
authors.affiliation: Paediatric Institute Hospital Kuala Lumpur, Kuala Lumpur 50586, Malaysia.
authors.forename: Kamarul
authors.initials: K
authors.lastname: Razali
authors.affiliation: TREAT Asia/amfAR-The Foundation for AIDS Research, Bangkok 10330, Thailand.
authors.forename: Annette H
authors.initials: AH
authors.lastname: Sohn
authors.affiliation: The Kirby Institute, University of New South Wales, Sydney, NSW 2052, Australia.
authors.forename: Azar
authors.initials: A
authors.lastname: Kariminia
keywords: Antiretroviral therapy; Asia; HIV-infected children; severe anemia