Preliminary outcomes of a paediatric highly active antiretroviral therapy cohort from KwaZulu-Natal, South Africa

Sinikithemba HIV/AIDS Clinic, McCord Hospital, Durban, South Africa.
BMC Pediatrics (Impact Factor: 1.92). 02/2007; 7:13. DOI: 10.1186/1471-2431-7-13
Source: PubMed

ABSTRACT Few studies address the use of paediatric highly active antiretroviral therapy (HAART) in Africa.
We performed a retrospective cohort study to investigate preliminary outcomes of all children eligible for HAART at Sinikithemba HIV/AIDS clinic in KwaZulu-Natal, South Africa. Immunologic, virologic, clinical, mortality, primary caregiver, and psychosocial variables were collected and analyzed.
From August 31, 2003 until October 31, 2005, 151 children initiated HAART. The median age at HAART initiation was 5.7 years (range 0.3-15.4). Median follow-up time of the cohort after HAART initiation was 8 months (IQR 3.5-13.5). The median change in CD4% from baseline (p < 0.001) was 10.2 (IQR 5.0-13.8) at 6 months (n = 90), and 16.2 (IQR 9.6-20.3) at 12 months (n = 59). Viral loads (VLs) were available for 100 children at 6 months of which 84% had HIV-1 RNA levels < or = 50 copies/mL. At 12 months, 80.3% (n = 61) had undetectable VLs. Sixty-five out of 88 children (73.8%) reported a significant increase (p < 0.001) in weight after the first month. Eighty-nine percent of the cohort (n = 132) reported < or = 2 missed doses during any given treatment month (> 95%adherence). Seventeen patients (11.3%) had a regimen change; two (1.3%) were due to antiretroviral toxicity. The Kaplan-Meier one year survival estimate was 90.9% (95%confidence interval (CI) 84.8-94.6). Thirteen children died during follow-up (8.6%), one changed service provider, and no children were lost to follow-up. All 13 deaths occurred in children with advanced HIV disease within 5 months of treatment initiation. In multivariate analysis of baseline variables against mortality using Cox proportional-hazards model, chronic gastroenteritis was associated with death [hazard ratio (HR), 12.34; 95% CI, 1.27-119.71) and an HIV-positive primary caregiver was found to be protective against mortality [HR, 0.12; 95% CI, 0.02-0.88). Age, orphanhood, baseline CD4%, and hemoglobin were not predicators of mortality in our cohort. Fifty-two percent of the cohort had at least one HIV-positive primary caregiver, and 38.4% had at least one primary caregiver also on HAART at Sinikithemba clinic.
This report suggests that paediatric HAART can be effective despite the challenges of a resource-limited setting.

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    • "It is known that mothers tend to hide HIV infection status from their children and disclosure is often delayed until adolescence [33]. Reddi and colleagues show that only 7.9% children had been made aware of their own HIV infection status in their study in South Africa [34]. Disclosure of HIV infection status is a critical step and has obvious implications for adherence. "
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    AIDS research and treatment 02/2012; 2012:574656. DOI:10.1155/2012/574656
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    • "Several studies have demonstrated that the efficacy of HAART in HIV-infected children in resource-limited countries is comparable to that of children in resource-rich countries [11] [12] [13] [14] [15] [16] [17] [18] [19]. Given the empirical obstacles of using the standard of care for monitoring HAART therapy in resource-limited countries and the need to develop clinical practices that would reduce the overall cost of patient care, we investigated factors affecting treatment response among HIV-positive children on HAART in a resource-limited country. "
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    AIDS research and treatment 05/2011; 2011:896040. DOI:10.1155/2011/896040
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    • "Preliminary work from the United States (US) suggests that HIV+ youth are at risk for health and mental health problems, as well as substance use, early sexual debut and unprotected sex which presents a public health concern (Havens & Mellins, 2008; Ledlie, 2000; Mellins, Brackis-Cott, Dolezal, et al., 2006). Adherence to ART is also a challenge for HIV+ adolescents given their changing developmental stage, partial reliance on caregivers, interference with daily routines, peer affiliation needs, and complex dosing regimens, all of which may lead to increased non-adherence, and ultimately ART resistance (e.g., Bikaako-Kajura et al., 2006; Havens & Mellins, 2008; Reddi et al., 2007). "
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