for Medecins Sans Frontieres. In resource-limited settings good early outcomes can be achieved in children using adult fixed-dose combination antiretroviral therapy

Doctors Without Borders, Lutetia Parisorum, Île-de-France, France
AIDS (Impact Factor: 6.56). 10/2006; 20(15):1955-60. DOI: 10.1097/01.aids.0000247117.66585.ce
Source: PubMed

ABSTRACT To (a) determine early treatment outcomes and (b) assess safety in children treated with adult fixed-dose combination (FDC) antiretroviral tablets.
Sixteen Medecins Sans Frontieres (MSF) HIV programs in eight countries in resource-limited settings (RLS).
Analysis of routine program data gathered June 2001 to March 2005.
A total of 1184 children [median age, 7 years; inter-quartile range (IQR), 4.6-9.3] were treated with antiretroviral therapy (ART) of whom 616(52%) were male. At ART initiation, Centres for Disease Control stages N, A, B and C were 9, 14, 38 and 39%, respectively. Children were followed up for a median period of 6 months (IQR, 2-12 months). At 12 months the median CD4 percentage gain in children aged 18-59 months was 15% (IQR, 6-18%), and the percentage with CD4 gain < 15% was reduced from 85% at baseline to 11%. In those aged 60-156 months, median CD4 cell count gain was 275 cells/microl (IQR, 84-518 cells/microl), and the percentage with CD4 < 200 cells/mul reduced from 51% at baseline to 11%. Treatment outcomes included; 1012 (85%) alive and on ART, 36 (3%) deaths, 15 (1%) stopped ART, 89 (8%) lost to follow-up, and 31 (3%) with unknown outcomes. Overall probability of survival at 12 months was 0.87 (0.84-0.89). Side effects caused a change to alternative antiretroviral drugs in 26 (2%) but no deaths.
Very satisfactory early outcomes can be achieved in children in RLS using generic adult FDC antiretroviral tablets. These findings strongly favour their use as an "interim solution" for scaling-up ART in children; however, more appropriate pediatric antiretroviral drugs remain urgently needed.

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    • "Adapted from ( in 1996 significantly reduced the morbidity and mortality in HIV-infected children in both resource-rich countries [11] [12] and resource-limited countries [13] [14] [15] [16] [17]. However, the treatment of HIV infection is a life-long undertaking, and therapeutic benefit can be limited by the evolution of drugresistant virus and long-term toxicity resulting in treatment failure [18] [19]. "
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    AIDS research and treatment 01/2011; 2011(2090-1240):280901. DOI:10.1155/2011/280901
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    • "This is also a consequence of poor access to appropriate ART formulations for children and the difficulty in dosing young children even where liquid formulations and refrigeration are available, due to the requirement for surface-area dosing. In fact, in Malawi, the site of three of the cohorts, all children were treated with split doses of the adult fixed-dose combination (FDC) Triomune (d4T/3TC/ NVP) according to weight bands (Bong et al., 2007; Ellis & Molyneux, 2007; Malawi Paediatric Antiretroviral Treatment Group, 2007), while one of the multi-country MSF cohort studies had the specific aim of demonstrating feasibility and good outcomes with use of adult FDCs in children (O'Brien et al., 2006). . While the Malawian studies highlight the problems of dosing the smallest children (<8 kg) with tablet once daily (which is not recommended, as d4T should be given twice daily: (WHO, 2006), Ellis & Molyneux (2007) argue that the good outcomes reported support use of this regimen due to the benefits of low cost, availability and simplicity. "
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    ABSTRACT: Knowledge of the experience and outcomes of current paediatric antiretroviral treatment (ART) programmes in sub-Saharan Africa can inform new programmes in the region as well as enhance existing ones. This is urgently needed to facilitate the scale-up of treatment, which is needed to address the burden of paediatric HIV cases on the continent. We reviewed the characteristics and outcomes of programmes with clinical paediatric ART studies published prior to 1 January 2008. The outcomes of the studies were comparable to similar ones from developed countries; however, the duration of follow-up was relatively limited in almost all the studies reviewed. One-year survival probability was between 84% and 91%, and considerable improvement in the clinical, immunologic and viral status of the paediatric patients was generally recorded. Loss to follow-up was less than 10% in all but two studies. Adherence to treatment was good and few adverse events were reported. This is despite the fact that many programmes were subject to enormous constraints in terms of health services, and despite widespread use of adult fixed-dose combinations for paediatric patients, including young infants. While the majority of children commencing ART were severely ill, most children were old (median age > 5 years for almost all studies) with relatively few infants and young children (age < 2 years) receiving treatment. This is in contrast to knowledge of rapid disease progression in the majority of HIV-infected infants and despite the World Health Organization's recent recommendations to commence ART in all HIV-infected infants less than one year old. There is an urgent need to address barriers to ART for infants. Studies of the outcomes of programmes treating infants as well as those with longer-term follow-up are also needed.
    African Journal of AIDS Research 10/2009; 8(3):329-338. DOI:10.2989/AJAR.2009. · 0.61 Impact Factor
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