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: 1.93). 02/2007; 7(1):13. DOI: 10.1186/1471-2431-7-13
Source: PubMed


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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    • "The study conducted in Addis Ababa, Ethiopia shows that the most common reasons for missing dose were lack of medication, the child slept and forgetfulness to give the drugs [11] while the survey conducted in the Aminu Kano Teaching Hospital, Nigeria reported that running out of medication and the inability to purchase, travelling difficulty, forgetfulness, and children sleeping as adherence barriers [17]. Similarly, common reasons reported for missed doses in KwaZulu-Natal, South Africa were financial trouble that prevented caregivers from collecting medication on time, vomiting of medication without re-dosing, incorrect dosing by a caregiver, missed clinic appointments and pharmacy collections, confusion between multiple caregivers, and child refusal or self-discontinuation [22]. This may suggest that there is an expanded access to antiretroviral therapy for child patients receiving treatment in the present survey. "
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