Effectiveness of antiretroviral therapy among HIV-infected children in sub-Saharan Africa
Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA. The Lancet Infectious Diseases
(Impact Factor: 22.43).
08/2008; 8(8):477-89. DOI: 10.1016/S1473-3099(08)70180-4
Assessment of antiretroviral treatment programmes for HIV-infected children in sub-Saharan Africa is important to enable the development of effective care and improve treatment outcomes. We review the effectiveness of paediatric antiretroviral treatment programmes in sub-Saharan Africa and discuss the implications of these findings for the care and treatment of HIV-infected children in this region. Available reports indicate that programmes in sub-Saharan Africa achieve treatment outcomes similar to those in North America and Europe. However, progress in several areas is required to improve the care of HIV-infected children in sub-Saharan Africa. The findings emphasise the need for low-cost diagnostic tests that allow for earlier identification of HIV infection in infants living in sub-Saharan Africa, improved access to antiretroviral treatment programmes, including expansion of care into rural areas, and the integration of antiretroviral treatment programmes with other health-care services, such as nutritional support.
Available from: Dongchi Zhao
- "Our results are similar to those from resource-rich settings , although the children from resource-rich settings were mainly ART non-native and less immunosuppressed, and were treated mainly with protease inhibitor-containing regimens . These data suggest that better outcomes are achieved regardless of when ART is started provided it is started before profound immunosuppression develops . "
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Antiretroviral therapy (ART) reduces HIV-related mortality and morbidity substantially in children. The clinical characteristics, immunological and virological outcomes were evaluated in HIV-infected children receiving ART.
Twenty-six HIV-1-infected children receiving ART in Hubei province, China, were enrolled retrospectively in this study. During the period of ART, plasma viral load, lymphocyte phenotype of CD4 and CD8 cells and clinical events were assessed.
The median duration of ART was 41 months (18–72.3 months). In children showing clinical improvement, high viral suppression rate below log10 (2.7) copies/ml by the third months of ART was observed. The median CD4 cell counts reached to 820.5/μl by 12 months and the median ratio of CD4/CD8 increased to 0.6 by 21 months. The counts of peripheral white blood cells and red blood cells decreased in the first 12 months, while Hb concentration, MCV and MCH increased (P < 0.001).
Despite the limited small sample size, ART is an effective strategy for inhibiting HIV replication and reconstructing the immunological response in children with AIDS.
Available from: Anna M Rose
- "In recent years, there has been a dramatic increase in the proportion of HIV-positive individuals on treatment: for example, in one hyperendemic region in Southern Africa, since the ART programme ‘scale-up’, there has been an increase from 0% in 2004 to 31% in 2011.44 Use of ART has led to a decrease in morbidity and mortality in HIV-positive children in RLS. Despite widespread advances in the availability of ART, there remains a disparity between the number of children who require ART and the number receiving treatment; furthermore, initiation of therapy occurs late in children with already advanced disease.5 Initiation of ART is associated with a sustained improvement in growth responses, especially in younger children, even in the absence of complete viral suppression.45–47 The direct effect of ART on growth, as well as the decreased frequency of opportunistic infections in children receiving ART, means that absence (or late initiation) of ART treatment can be considered a risk factor for development of malnutrition in HIV-positive children. "
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ABSTRACT: Worldwide, more than 3 million children are infected with HIV and, without treatment, mortality among these children is extremely high. Both acute and chronic malnutrition are major problems for HIV-positive children living in resource-limited settings. Malnutrition on a background of HIV represents a separate clinical entity, with unique medical and social aetiological factors. Children with HIV have a higher daily calorie requirement than HIV-negative peers and also a higher requirement for micronutrients; furthermore, coinfection and chronic diarrhoea due to HIV enteropathy play a major role in HIV-associated malnutrition. Contributory factors include late presentation to medical services, unavailability of antiretroviral therapy, other issues surrounding healthcare provision and food insecurity in HIV-positive households. Treatment protocols for malnutrition have been greatly improved, yet there remains a discrepancy in mortality between HIV-positive and HIV-negative children. In this review, the aetiology, prevention and treatment of malnutrition in HIV-positive children are examined, with particular focus on resource-limited settings where this problem is most prevalent.
Available from: Robin Wood
- "Timely ART initiation is important especially in infants and young children where disease progression is rapid and mortality is high , . Even after ART initiation, early mortality remains very high in children with advanced disease, whereas starting ART with less advanced disease is associated with a good prognosis in terms of mortality, immunological, growth and neurodevelopmental outcomes , , , , , . There have been few articles published examining temporal trends in children initiating ART in sub-Saharan Africa , , , . "
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ABSTRACT: Since 2005, increasing numbers of children have started antiretroviral therapy (ART) in sub-Saharan Africa and, in recent years, WHO and country treatment guidelines have recommended ART initiation for all infants and very young children, and at higher CD4 thresholds for older children. We examined temporal changes in patient and regimen characteristics at ART start using data from 12 cohorts in 4 countries participating in the IeDEA-SA collaboration.
Data from 30,300 ART-naïve children aged <16 years at ART initiation who started therapy between 2005 and 2010 were analysed. We examined changes in median values for continuous variables using the Cuzick's test for trend over time. We also examined changes in the proportions of patients with particular disease severity characteristics (expressed as a binary variable e.g. WHO Stage III/IV vs I/II) using logistic regression. Between 2005 and 2010 the number of children starting ART each year increased and median age declined from 63 months (2006) to 56 months (2010). Both the proportion of children <1 year and ≥10 years of age increased from 12 to 19% and 18 to 22% respectively. Children had less severe disease at ART initiation in later years with significant declines in the percentage with severe immunosuppression (81 to 63%), WHO Stage III/IV disease (75 to 62%), severe anemia (12 to 7%) and weight-for-age z-score<-3 (31 to 28%). Similar results were seen when restricting to infants with significant declines in the proportion with severe immunodeficiency (98 to 82%) and Stage III/IV disease (81 to 63%). First-line regimen use followed country guidelines.
Between 2005 and 2010 increasing numbers of children have initiated ART with a decline in disease severity at start of therapy. However, even in 2010, a substantial number of infants and children started ART with advanced disease. These results highlight the importance of efforts to improve access to HIV diagnostic testing and ART in children.
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