Affiliation:
1. Departments of Pediatrics
2. Family Care Clinic, Coast Province General Hospital, Mombasa, Kenya
3. Pediatric Infectious Diseases, New York University, New York, New York
Abstract
OBJECTIVE. Few studies have investigated the efficacy of antiretroviral therapy among HIV-infected children in resource-poor settings. This observational, retrospective analysis describes the clinical, immunologic, and virologic effects of highly active antiretroviral therapy in treatment-naive, HIV-infected children in Mombasa, Kenya. In keeping with a public health approach, all children were treated by using a simplified, nationally approved, triple-drug regimen.
METHODS. Clinical data and stored plasma samples from 29 children who were followed prospectively between April 2003 and October 2004 were analyzed. All children received generic formulations of nevirapine, zidovudine, and lamivudine and were evaluated at baseline and at 3, 6, 9, 12, and 15 months. At each visit, weight and CD4 lymphocyte counts were measured and plasma samples were stored for analysis. HIV RNA load was determined retrospectively at baseline and 9 months after initiation of therapy.
RESULTS. The mean age of the children was 8.5 years (range: 2–16 years). At baseline, the mean CD4 count (±SD) was 182.3 × 106 cells per μL (±145.6). On treatment, CD4 counts increased step-wise by a mean of 187 × 106 cells per μL at 3 months, 293 cells per μL at 6 months, 308 cells per μL at 9 months, 334 cells per μL at 12 months, and 363 cells per μL at 15 months. The mean plasma viral load decreased from a baseline level of 622 712 to 35369 copies per mL, and at 9 months was undetectable in 55% of the patients. Mean z scores for weight for age increased from a baseline of −1.61 to −1.12 at 12 months into therapy.
CONCLUSIONS. A public health approach using 1 treatment regimen in generic form showed excellent efficacy among treatment-naive, HIV-infected children in a resource-limited country. Clinical and immunologic improvement occurred in all patients, but 9 months after the start of therapy, only 55% of the children had an undetectable viral load.
Publisher
American Academy of Pediatrics (AAP)
Subject
Pediatrics, Perinatology, and Child Health
Reference30 articles.
1. Joint United Nations Programme on HIV/AIDS, WHO. Report on the Global HIV/AIDS Epidemic. Geneva, Switzerland: Joint United Nations Programme on HIV/AIDS and World Health Organization; 2004. Available at: www.unaids.org/bangkok2004/GAR2004_html/GAR2004_03_en.htm#P237_35114. Accessed January 29, 2007
2. United Nations Children's Fund. The State of the World's Children 2006. New York, NY: United Nations Children's Fund; 2005. Available at: www.unicef.org/publications/files/SOWC_2005_(English).pdf. Accessed January 29, 2007
3. Joint United Nations Programme on HIV/AIDS/World Health Organization. Treating 3 Million by 2005: Making It Happen—The WHO Strategy. Geneva, Switzerland: World Health Organization; 2005. Available at: www.who.int/3by5/en. Accessed January 29, 2007
4. Nicoll A, Timaeus I, Kigadye RM, Walraven G, Killewo J. The impact of HIV-1 infection on mortality in children under 5 years of age in sub-Saharan Africa: a demographic and epidemiologic analysis. AIDS. 1994;8:995–1005
5. Spira R, Lepage P, Msellati P, et al. Natural history of human immunodeficiency virus type 1 infection in children: a five-year prospective study in Rwanda. Pediatrics. 1999:104(5). Available at: www.pediatrics.org/cgi/content/full/104/5/e56
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