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JAIDS Journal of Acquired Immune Deficiency Syndromes 01/2013; 62(1):e27-e29. · 4.43 Impact Factor
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ABSTRACT: This study aimed to determine the prevalence of hepatitis B virus (HBV) coinfection and HBV seropositivity in perinatally HIV-infected adolescents. A secondary objective was to describe the clinical characteristics of adolescents with chronic HBV/HIV coinfection.
Multicenter cross-sectional study of perinatally HIV-infected adolescents aged 12-25 years. HBV surface antigen, surface antibody (anti-HBs) and core antibody (anti-HBc) were measured. Coinfection was defined as having persistently positive HBV surface antigen. Seroprotective antibody from immunization was defined as having anti-HBs ≥10 mIU/mL with negative anti-HBc. HBV DNA quantitation and rtM204V/I mutation analysis (lamivudine resistance-associated mutation) were performed in adolescents with chronic HBV infection.
From November 2010 to March 2011, 521 patients were enrolled. Mean (SD) of CD4 lymphocyte count was 685 (324) cells/μL. The prevalence of HBV/HIV coinfection was 3.3% (95% confidence interval: 1.9-5.2%). Protective antibody against HBV was found in 18% of population, and this was significantly higher among adolescents who received than those who did not receive HBV revaccination after receiving antiretroviral therapy (93% versus 6%, P < 0.01). Among adolescents with chronic HBV infection, 88% have received lamivudine; however, 69% have HBV DNA >10 copies/mL and 75% had the rtM204V/I mutation.
The prevalence of HBV coinfection in HIV-infected Thai adolescents was 3.3%. Most HIV-infected adolescents had no HBV protective antibody; therefore, revaccination with HBV vaccine is encouraged. The high prevalence of HBV-lamivudine resistance underscores the importance of HBV screening prior to antiretroviral therapy initiation to guide the selection of optimal regimen for coinfected children.
The Pediatric Infectious Disease Journal 05/2012; 31(9):943-7. · 3.58 Impact Factor
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ABSTRACT: Substitution of stavudine with zidovudine may lead to recovery from lipodystrophy (LD) in HIV-infected children.
We prospectively followed HIV-infected children enrolled in an earlier LD study conducted between 2002 and 2004 at Chiang Mai University Hospital in northern Thailand. In 2006, stavudine was substituted with zidovudine. All children were evaluated by a clinical LD checklist modified from that of the European Pediatric LD study group together with waist/hip measurement at baseline and 24, 48, 72, and 96 weeks after substitution. The waist-to-hip ratios were converted to age- and sex-adjusted z scores based on normal ranges in healthy Thai children.
Forty-five lipodystrophic children with 36 episodes of lipohypertrophy and 22 episodes of lipoatrophy were enrolled. By weeks 48 and 96 after substitution, 40% and 47% of lipohypertrophy resolved, whereas 59% and 73% of lipoatrophy resolved, respectively. The rate of resolution of lipoatrophy was higher than that of lipohypertrophy at 48 weeks after substitution and thereafter. Ninety-six weeks after changing to zidovudine therapy, 8 children still had LD (1 with both lipoatrophy and lipohypertrophy, 7 with lipohypertrophy). No clinically significant hematologic adverse event was observed.
Substitution of stavudine with zidovudine resulted in decreased severity or resolution of LD among HIV-infected children and adolescents.
The Pediatric Infectious Disease Journal 11/2011; 31(4):384-8. · 3.58 Impact Factor
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ABSTRACT: To evaluate the immunogenicity and safety of the monovalent pandemic influenza A (H1N1) 2009 (pH1N1) vaccine in HIV-infected Thai children, 2 doses, 28days apart, of non-adjuvant monovalent pH1N1 vaccine (Panenza(®) by Sanofi Pasteur, 15μg/dose) provided by the National Health Promotion Program of the Thai Ministry of Public Health were given to HIV-infected children. Immunogenicity was measured by hemagglutination inhibition test (HAI) using two antigens, pH1N1 (A/Thailand/104/09) and seasonal influenza A H1N1 (A/Brisbane/59/07-like), at baseline, and 28days after each dose. Serologic response was defined as four-fold rising of HAI titer or HAI titer ≥1:40 for those with baseline titer ≤1:10. Adverse events were recorded for 7days after each vaccination. Of the 119 HIV-infected children enrolled, 60 (50.4%) were female with a median (IQR) age of 10.4 (7.2-13.7)years. All but 2 (98.3%) children were receiving antiretroviral therapy. At baseline, the median CD4 cell count was 782 (570-1149)cells/mm(3), 91 (80.5%) children had HIV RNA level <40copies/ml. The baseline HAI titer ≥1:40 for pH1N1 and seasonal H1N1 were 45.4%, and 39.5%, respectively. At 28 days after doses 1 and 2, the serologic response rates for pH1N1 were 54.2% and 67.8% with the geometric mean titer of 109.9 and 141.8; and serologic response rate when tested with seasonal H1N1 were 2.5% and 3.5%, respectively. The presence of baseline HAI titer for pH1N1 or seasonal H1N1 was found to be associated with serologic response. The vaccine was well tolerated. The results suggested that monovalent pH1N1 vaccine was immunogenic and safe in well controlled HIV-infected children with low level of cross reacting antibody to seasonal H1N1.
Vaccine 09/2011; 29(47):8705-11. · 3.77 Impact Factor
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ABSTRACT: After responding to highly active antiretroviral therapy (HAART), HIV-infected children had a good response to hepatitis B immunization. However, there are limited data on the durability of antibody to hepatitis B surface antigen (anti-HBs) in these children. The primary objective of this study is to determine the prevalence of protective anti-HBs level 3 years after a 3-dose HBV revaccination among HIV-infected children with immune recovery (CD4 cell ≥ 15%) while on HAART. The secondary objective is to assess immunologic memory among children who had waning of anti-HBs. An anti-HBs level of ≥ 10 mIU/mL was defined as a protective antibody level. Sixty-nine HIV-infected children who had history of a 3-dose HBV revaccination while receiving HAART were enrolled. The mean (SD) of CD4 cell and duration of HAART at time of revaccination was 27.2% (6.7) and 5.9 years (0.4), respectively. The proportion of children with protective anti-HBs level 3 years after the revaccination was 71.0% [95% CI, 58.8-81.3]. The geometric mean titer was 114(SD 5)IU/mL. By multivariate logistic analysis, the predictors for protective anti-HBs level 3 years after revaccination were CD4 cell count ≥ 500 cells/mm³ at the time of vaccination (p = 0.04) and anti-HBs level ≥ 100 IU/mL at 1 month after completion of the 3-dose vaccination (p < 0.001). Anamnestic response after one booster dose was demonstrated among 14 of 17 children who had waning protective anti-HBs level (82.4% [95% CI, 62.2-102.6]). Our findings support the recommendation of giving a 3-dose HBV vaccination to HIV-infected children with immune recovery while receiving HAART.
Vaccine 05/2011; 29(23):3977-81. · 3.77 Impact Factor
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Kulkanya Chokephaibulkit,
Tim R Cressey,
Edmund Capparelli,
Virat Sirisanthana,
Petronella Muresan,
Suchat Hongsiriwon,
Chaiwat Ngampiyaskul,
Chanin Limwongse,
Orasri Wittawatmongkol, Linda Aurpibul,
Bill Kabat,
MariPat Toye,
Mary Elizabeth Smith,
Achara Eksaengsri,
Kenneth McIntosh,
Ram Yogev
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ABSTRACT: Alternatives to the available stavudine-containing paediatric fixed-dose combination (FDC) tablets are rapidly needed due to concerns regarding the cumulative toxicity of long-term stavudine exposure. We report the bioavailability and short-term safety of a novel paediatric FDC tablet of zidovudine (ZDV)/lamivudine (3TC)/nevirapine (NVP; 30/15/28 mg) in HIV-infected children.
In this Phase I/II open-label pharmacokinetic study, 42 children weighing 6-30 kg treated with NVP-based HAART for ≥4 weeks were randomized to receive the FDC tablets (GPO-VIR Z30) or the liquid formulations. Dosing was weight-based. Intensive 12-h blood sampling was performed after 2 weeks; subjects then crossed-over to the alternate formulation at equal doses and sampling repeated 2 weeks later. Pharmacokinetic parameters were determined by non-compartmental analysis. Buccal-swab samples were collected for cytochrome P450 (CYP)2B6 polymorphism analysis.
With the FDC tablet, the geometric mean (90% CI) area under the curve (AUC) for ZDV, 3TC and NVP was 1.58 (1.49-1.68), 7.78 (7.38-8.19) and 68.88 (62.13-76.36) μg•h/ml, respectively. Rules for NVP therapeutic inadequacy were defined a priori, and despite lower NVP exposure with the tablet (P<0.001), the levels remained therapeutically adequate. ZDV AUC was similar between formulations. 3TC exposure was significantly higher with the tablet but comparable to historical data in adults and children taking branded tablets. While receiving the tablet, NVP AUC in children with CYP2B 516 GG (45%), GT (45%) and TT (10%) genotypes were 67.0, 74.5 and 106.4 μg•h/ml, respectively (P=0.04).
Disparities in drug exposure between formulations were observed; however, the FDC tablet delivered therapeutically adequate exposures of each drug and could well play an important role in simplifying antiretroviral treatment for children.
Antiviral therapy 01/2011; 16(8):1287-95. · 3.16 Impact Factor
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Pagakrong Lumbiganon,
Azar Kariminia, Linda Aurpibul,
Rawiwan Hansudewechakul,
Thanyawee Puthanakit,
Nia Kurniati,
Nagalingeswaran Kumarasamy,
Kulkanya Chokephaibulkit,
Nik Khairulddin Nik Yusoff,
Saphonn Vonthanak,
Fong Siew Moy,
Kamarul Azahar Mohd Razali,
Revathy Nallusamy,
Annette H Sohn
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ABSTRACT: Combination antiretroviral therapy (ART) has been used for HIV-infected children in many Asian countries since 2002. This study describes survival outcomes among HIV-infected children in a multicenter regional cohort in Asia.
Retrospective and prospective data collected through March 2009 from children in 5 countries enrolled in TREAT Asia's Pediatric HIV Observational Database were analysed. Multivariate Cox proportional hazard models were used to assess factors associated with mortality in children who received ART.
Among 2280 children, 1752 (77%) had received ART. During a median follow-up of 3.1 years after ART, 115 (6.6%) deaths occurred, giving a crude mortality rate of 1.9 per 100 child-years [95% confidence interval (CI): 1.6 to 2.4]. The mortality rate was highest in the first 3 months of ART (10.2 per 100 child-years; 95% CI: 7.5 to 13.7) and declined after 12 months (0.9 per 100 child-years; 95% CI: 0.7 to 1.3). Those with a low recent CD4 percentage, who started ART with lower baseline weight-for-age Z score, or with WHO clinical stage 4 had an increased risk of death. Of 528 (23%) children who never received ART, 36 (6.8%) died after presenting to care, giving a crude mortality rate of 4.1 per 100 child-years (95% CI: 3.0 to 5.7), with a lost-to-program rate of 31.5 per 100 child-years (95% CI: 28.0 to 35.5).
The high mortality during the first 3 months of ART and in those with low CD4 percentage support the implementation of early diagnosis and ART initiation.
JAIDS Journal of Acquired Immune Deficiency Syndromes 12/2010; 56(4):365-71. · 4.43 Impact Factor
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ABSTRACT: Among HIV-infected children who had immune recovery after received antiretroviral therapy (ART), good responses to revaccination with childhood vaccines have been observed. However, the rate of long-term persistence of antibody response remains unknown. The objective of this study is to determine whether HIV-infected children still have protective antibody against Japanese encephalitis virus (JE) 3 years after receiving revaccination with two doses of inactivated JE vaccine. Plasma JE neutralizing antibody titer was determined by a plaque reduction neutralization assay. An antibody titer of more than 1:10 was defined as being protective. Fifty HIV-infected children with a mean age of 10.3 years (SD 2.2) and mean CD4 percentage of 25 (SD 5) were revaccinated with two doses of inactivated JE vaccine. Forty-three children had been followed-up for 3 years. The JE neutralizing antibody at 1 month and 3 years after revaccination were detected among 38 (88%) and 35 (81%) children, respectively. The geometric means titer significantly dropped from of 306 (min 13-max 163,617) to 106 (min 11-max 4645). This data show that the majority of HIV-infected children had persistent antibody 3 years after revaccination. JE revaccination in HIV-infected children with immune recovery after ART should be carried out in endemic areas.
Vaccine 08/2010; 28(36):5900-2. · 3.77 Impact Factor
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ABSTRACT: Three years after measles, mumps, and rubella revaccination in 38 human immunodeficiency virus-infected children who had achieved immune recovery after antiretroviral therapy, the prevalence of protective antibody levels was 85% for measles, 61% for mumps, and 79% for rubella, compared with 88%, 84%, and 100%, respectively, 1 month after revaccination.
Clinical Infectious Diseases 04/2010; 50(10):1415-8. · 9.15 Impact Factor
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ABSTRACT: Neurocognitive outcome is an essential aspect of treatment for HIV-infected children. This study is aimed at assessing cognitive functioning in school-aged HIV-infected children and the change after receiving antiretroviral therapy (ART). We conducted a prospective cohort study of HIV-infected Thai children from 6-12 years of age compared with HIV-affected (children of HIV-positive mothers who were not infected with HIV), and normal control groups. Wechsler Intelligence Scale for Children-III (WISC-III) was administered at enrollment and 30 months of follow-up. Semistructured interviews of primary caregivers were performed. From April to October 2003, 121 children were enrolled; 39 HIV-infected, 40 HIV-affected, and 42 control children with a median age of 9.3 years. The HIV-infected group had a mean (standard deviation [SD]) CD4 percentage of 13.8% (5.3), 87% of whom had been receiving ART for a median of 35 weeks. At the first cognitive assessment, the mean (SD) of full-scale intelligence quotient (FSIQ) was 79 (13) and 88 (10) among HIV-infected and HIV-affected children, which was statistically lower than that of the control group at 96 (13; p < 0.01). The proportion of children with average intelligence level (FSIQ > 90) among 3 groups were 21%, 49%, and 76%, respectively (p < 0.01). At 30 months of follow-up, the HIV-infected group had a mean (SD) CD4 percentage of 25.6% (5.6); 77% had undetectable viral load. The mean (SD) FSIQ of children among three groups were 75 (12), 85 (12), and 91 (12), respectively. Compared with the baseline assessment, the verbal scale score significantly decreased in all groups, including the controls, whereas the performance scales did not change. In conclusion, school-aged HIV-infected children have lower cognitive function than HIV-affected and normal children. Cognitive function was not improved after receiving ART. Further study to address whether early ART can preserve cognitive functioning among HIV-infected children should be explored.
AIDS patient care and STDs 03/2010; 24(3):141-6. · 2.68 Impact Factor
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ABSTRACT: An outbreak of measles occurred in an orphanage in Chiang Mai, Thailand where 44 HIV-infected and 19 HIV-uninfected children were accommodated. History of measles vaccination was significantly correlated with the risk of acquiring measles, where HIV infection status was not.
The Pediatric Infectious Disease Journal 11/2009; 29(2):167-9. · 3.58 Impact Factor
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ABSTRACT: Growth failure is a common problem in HIV-infected children. The extent to which this growth failure could be reversed after the children receive antiretroviral therapy (ART) is not known. This study assessed the incidence of growth failure in HIV-infected Thai children, impact of ART on growth, and the predictors of growth reversal after initiating ART. Growth parameters and other characteristics were extracted from the database of a prospective cohort of HIV-infected children (age <or=15 years) who were enrolled to initiate non-nucleoside reverse transcriptase inhibitor-based ART between August 2002 and May 2007. Body weight and height measurements, CD4 cell counts, plasma HIV RNA levels were collected at baseline and 24-week intervals. A total of 225 HIV-infected children were included, 116 (51%) were males. The median age at baseline was 7.4 years (interquartile range [IQR] 5.2-9.8). Fifty-three percent were in Centers for Disease Control and Prevention (CDC) category C and 54% had CD4 percentage 5 or less. The mean (standard deviation [SD]) of baseline weight-for-age (WAZ) and height-for-age (HAZ) z-scores were -2.02 (1.17) and -2.22 (1.51). The median follow-up time was 216 weeks (IQR 120-240). The cumulative probability of growth reversal among the 179 subjects with growth failure at entry was 58% (95% confidence interval [CI] 49-67) at week 240. In a multivariate Cox regression model, higher entry WAZ (p < 0.001) and HAZ (p < 0.001), use of a nevirapine-based regimen (compared to efavirenz, p = 0.027) and larger CD4% gains to week 48 (p < 0.001) were significant predictors of growth reversal after initiating ART. NNRTI-based ART leads to a substantial improvement in growth of HIV-infected children. Initiation of ART before the children developed growth failure should be encouraged.
AIDS patient care and STDs 11/2009; 23(12):1067-71. · 2.68 Impact Factor
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ABSTRACT: Concerns have been raised about the possibility of subtherapeutic efavirenz (EFV) plasma levels in children with the current dosing guideline. Single nucleotide polymorphisms of the hepatic cytochrome P450 isoenzyme 2B6 (CYP2B6) gene have been associated with high interindividual variations in EFV plasma concentrations. Our objective was to determine the adequacy of EFV dosing and explore the influence of CYP2B6-516G>T polymorphisms on EFV plasma concentrations in Thai HIV-infected children.
A total of 63 HIV-infected children receiving EFV for > or =4 weeks were assessed. Children received EFV daily doses on the basis of body weight bands. Between 12 to 16 h after EFV intake, a blood sample was drawn to measure the EFV plasma concentration and to determine the CYP2B6-516G>T polymorphism using HPLC and direct gene sequencing, respectively.
The median age (range) was 12.3 years (3.1-18.7). The mean (+/-sd) EFV plasma concentration was 3,138 ng/ml (3,313). Eight (13%), 45 (71%) and 10 (16%) children had an EFV concentration <1,000 ng/ml, 1,000-4,000 ng/ml and >4,000 ng/ml, respectively. CYP2B6-516 G/G, G/T and T/T genotypes were found in 48%, 41% and 11% children, respectively. The CYP2B6-516G>T allele frequency was 31.75%. The mean (+/-sd) EFV concentration for children with G/G, G/T and T/T genotypes were 1,604 ng/ml (729), 2,635 ng/ml (1,199) and 11,582 ng/ml (2,972), respectively (P<0.001). A correlation between EFV concentrations >4,000 ng/ml and psychiatric side effects was observed (P=0.02), but there was no association with rash, hepatotoxicity or central nervous system disturbances.
Current EFV dosing guidelines provide adequate plasma drug concentrations in Thai HIV-infected children. CYP2B6-516G>T polymorphisms significantly affect the drug metabolism of EFV in children.
Antiviral therapy 02/2009; 14(3):315-20. · 3.16 Impact Factor
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ABSTRACT: Twenty-six Thai HIV-infected children, aged 2 years or less were prospectively enrolled to receive non-nucleoside reverse transcription inhibitor-based highly active antiretroviral therapy (HAART). Twenty-two children (85%) had World Health Organization clinical stage 3 or 4. The median baseline CD4 cell percentage and plasma HIV RNA were 17% and 5.9 log 10 copies/mL, respectively. The median age at HAART initiation was 9.8 months (range, 1.5-24.0). One child died. The mean CD4 cell percentages at 24, 48, and 96 weeks of treatment were 26%, 31%, and 37%, respectively. The proportions of children with virologic suppression (<400 copies/mL) at week 24 and 48 were 14/26 (54%) and 19/26 (73%), respectively. Non-nucleoside reverse transcription inhibitor-based HAART is safe and effective in HIV-infected young children in a resource-limited setting.
The Pediatric Infectious Disease Journal 01/2009; 28(3):246-8. · 3.58 Impact Factor
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ABSTRACT: HIV-infected children are vulnerable to infections by vaccine preventable pathogens. However, they have poorer responses to childhood immunization than healthy children. The objectives of this study are to determine the prevalence of Japanese encephalitis (JE) protective antibody in HIV-infected children with immune recovery after highly active antiretroviral therapy (HAART) and evaluate response to JE revaccination. JE neutralizing antibody titer of plasma was determined by a plaque reduction neutralization assay. An antibody titer of more than 1:10 was defined as protective antibody. Children who did not have protective antibody to JE were enrolled to receive a two-dose JE revaccination during the study. There were 96 children with mean age of 9.7 years (S.D. 2.6) and mean CD4 percentage of 25 (S.D. 5) who participated in the study. Forty-four children (46%) had protective antibody to JE. A two-dose JE revaccination was administered to 50 children who did not have JE antibody. At 1 month after revaccination, 44 children (88%) developed protective antibody. This study demonstrated that there is a low prevalence of JE protective antibody in HIV-infected children despite history of JE primary childhood vaccination. However, the majority of HIV-infected children with immune recovery after HAART can develop protective antibody after JE revaccination.
Vaccine 12/2007; 25(49):8257-61. · 3.77 Impact Factor
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ABSTRACT: We report the long-term efficacy of highly active antiretroviral therapy (HAART) in 107 antiretroviral-naive human immunodeficiency virus (HIV)-infected Thai children. In an intention-to-treat analysis, 70% of the children had undetectable HIV RNA titers after 192 weeks of HAART. The mean CD4 cell percentage increased from 5.3% to 26.6%. HAART is effective for HIV-infected children in this resource-poor setting despite initiation of treatment in the advanced stage of disease.
The Pediatric Infectious Disease Journal 11/2007; 26(10):953-6. · 3.58 Impact Factor
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ABSTRACT: The low prevalence of measles antibody in human immunodeficiency virus (HIV)-infected children after immune recovery as a result of highly active antiretroviral therapy increases the risk of morbidity and mortality from disease. The objective of our study was to evaluate the efficacy and safety of revaccination with measles, mumps, and rubella (MMR) vaccine in HIV-infected children with immune recovery.
Inclusion criteria were (1) HIV-infected children aged >5 years, (2) a nadir CD4 lymphocyte percentage <or=15%, (3) immune recovery (defined as a CD4 lymphocyte percentage >15% for >or=3 months after highly active antiretroviral therapy), and (4) no protective antibody against measles. Each child received 1 dose of MMR vaccine, and antibodies were measured at 4 and 24 weeks after vaccination. Protective antibodies were defined as an antimeasles immunoglobulin G (IgG) level >or=320 mIU/mL, an antimumps IgG titer >1:500, and an antirubella IgG level >10 IU/mL.
There were 51 participants. The mean age (+/- standard deviation) was 10.2 +/- 2.5 years. Prior to revaccination, 28 participants (55%) had baseline protective antibody to mumps, and 11 (20%) had baseline protective antibody to rubella. The prevalence of protective antibody at 4 weeks was 90%, 100%, and 78% for measles, rubella, and mumps, respectively, and then slightly decreased to 80%, 94%, and 61%, respectively, at 24 weeks after revaccination. No serious adverse reactions were attributed to revaccination.
The majority of HIV-infected children with immune recovery can develop protective antibodies after MMR revaccination. Revaccination with MMR vaccine in HIV-infected children with immune recovery should be considered to ensure individual immunity and limit the spread of disease.
Clinical Infectious Diseases 09/2007; 45(5):637-42. · 9.15 Impact Factor
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ABSTRACT: Despite a history of hepatitis B virus (HBV) vaccination prior to highly active antiretroviral therapy (HAART), most of HIV-infected children do not have protective antibody to HBV infection. The efficacy of an additional booster dose in children with immune recovery on HAART remains unknown. This study was conducted to determine the response rate of HBV antibody after re-vaccination in HIV-infected children with immune recovery on HAART. Sixty-three successfully HAART-treated HIV-infected children with history of prior HBV vaccination received 10microg doses of recombinant HBV vaccine (Government Pharmaceutical Organization-Merieux Biological Product, Bangkok, Thailand) intramuscularly at 0, 2 and 6 months. The vaccine response rates were 17.4, 82.5, and 92.1% at 2, 6 and 7 months after the first dose of vaccine, respectively. Plasma HIV RNA level below the limit of detection at the time of re-vaccination was associated with successful vaccine response. HIV-infected children with immune recovery after HAART are likely to benefit from three-dose HBV re-vaccination.
Vaccine 08/2007; 25(29):5324-9. · 3.77 Impact Factor
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ABSTRACT: Pediatric antiretroviral therapy programs have recently been implemented in resource-limited settings. Their impact in a prospective cohort is not well documented. The aim of this study was to evaluate the rates and causes of hospitalization and mortality among human immunodeficiency virus (HIV)-infected Thai children after receiving highly active antiretroviral therapy (HAART).
Children who started receiving HAART from August 2002 to March 2005 were prospectively observed. The patients included in the study were antiretroviral-naive HIV-infected children who had CD4 cell percentages < or =15% before treatment. All patients were observed for at least 48 weeks.
One hundred ninety-two children were included. The mean age at HAART initiation was 7.6 years (range, 0.4-14.8 years). At baseline, the mean CD4 cell percentage (+/-SD) was 5.2%+/-4.9%, and the mean plasma HIV RNA level (+/-SD) was 5.4+/-0.5 log(10) copies/mL. Sixty-seven children (35%) were hospitalized a total of 108 times. The hospitalization rate decreased from 30.7% during the first 24-week period to 2.0% during weeks 120-144 after initiation of HAART. Fifty-nine hospital admissions (54.6%) occurred during the first 24 weeks of HAART. Causes of hospitalization were pneumonia and other bacterial infections (61.7%), immune reconstitution syndrome (23.4%), noninfectious illness (6.5%), opportunistic infection (5.6%), and drug-related events (2.8%). The mortality rate decreased from 5.7% in the first 24 weeks to 0%-0.6% in the subsequent 24-week intervals.
Hospitalization and mortality rates significantly decreased among HIV-infected children receiving HAART. Most hospitalizations and deaths occurred during the first 24 weeks of HAART.
Clinical Infectious Diseases 03/2007; 44(4):599-604. · 9.15 Impact Factor
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ABSTRACT: Highly active antiretroviral therapy (HAART) has recently been implemented in Thailand. Its long-term effects have not been clearly evaluated. The objective of this study was to estimate the prevalence of lipodystrophy (LD) and other metabolic changes in HIV-infected children receiving HAART.
Ninety children who began HAART (either nevirapine or efavirenz, together with lamivudine and stavudine) were prospectively followed. LD was assessed by waist-to-hip ratio and LD checklist. Hypercholesterolaemia was defined as total cholesterol > 200 mg/dl and low-density lipoprotein cholesterol > 130 mg/dl. Low levels of high-density lipoprotein cholesterol (HDL-c), hypertriglyceridaemia and hyperglycaemia were defined as HDL-c < 40 mg/dl, triglyceride > 200 mg/dl and plasma glucose > 110 mg/dl, respectively.
The mean age at entry was 7.6 (SD 2.9) years. Fifty-three children received nevirapine- and 37 received efavirenz-based HAART. The prevalence of LD was 9%, 47% and 65% at 48, 96 and 144 weeks after HAART initiation, respectively. Patterns of LD at week 144 were central lipohypertrophy (46%), peripheral lipoatrophy (20%), and combined type (34%). A higher prevalence of LD was found among females (61% versus 39%; P = 0.04) and those with more advanced disease (CDC category B or C) at baseline (73% versus 51%; P = 0.04). There was no difference in prevalence of LD between the two regimens. At 144 weeks, fasting hypertriglyceridaemia was detected in 12%, hypercholesterolaemia in 11%, and increased plasma glucose in 4% of children. Low HDL-cholesterolaemia decreased from 94% at baseline to 12% at week 144 (P < 0.01).
More than half of the children developed LD at 144 weeks after HAART. Dyslipidaemia occurred in 11-12% of children.
Antiviral therapy 02/2007; 12(8):1247-54. · 3.16 Impact Factor
