In Resource-Limited Settings Good Early Outcomes Can be Achieved in Children Using Adult Fixed-Dose Combination Antiretroviral Therapy.

Hdl Handle:
http://hdl.handle.net/10144/18289
Title:
In Resource-Limited Settings Good Early Outcomes Can be Achieved in Children Using Adult Fixed-Dose Combination Antiretroviral Therapy.
Authors:
O'Brien, D; Sauvageot, D; Zachariah, R; Humblet, P
Journal:
AIDS (London, England)
Abstract:
OBJECTIVES: To (a) determine early treatment outcomes and (b) assess safety in children treated with adult fixed-dose combination (FDC) antiretroviral tablets. SETTING: Sixteen Medecins Sans Frontieres (MSF) HIV programs in eight countries in resource-limited settings (RLS). METHODS: Analysis of routine program data gathered June 2001 to March 2005. RESULTS: 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. CONCLUSIONS: 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.
Affiliation:
AIDS Working Group, Medecins Sans Frontieres, Plantage Middenlaan 14, 1001 EA Amsterdam, The Netherlands. daniel.obrien@amsterdam.msf.org
Issue Date:
3-Oct-2006
URI:
http://hdl.handle.net/10144/18289
DOI:
10.1097/01.aids.0000247117.66585.ce
PubMed ID:
16988517
Language:
en
ISSN:
0269-9370
Appears in Collections:
Health Politics

Full metadata record

DC FieldValue Language
dc.contributor.authorO'Brien, D-
dc.contributor.authorSauvageot, D-
dc.contributor.authorZachariah, R-
dc.contributor.authorHumblet, P-
dc.date.accessioned2008-02-14T14:23:01Z-
dc.date.available2008-02-14T14:23:01Z-
dc.date.issued2006-10-03-
dc.identifier.citationIn Resource-Limited Settings Good Early Outcomes Can be Achieved in Children Using Adult Fixed-Dose Combination Antiretroviral Therapy. 2006, 20 (15):1955-60 AIDSen
dc.identifier.issn0269-9370-
dc.identifier.pmid16988517-
dc.identifier.doi10.1097/01.aids.0000247117.66585.ce-
dc.identifier.urihttp://hdl.handle.net/10144/18289-
dc.description.abstractOBJECTIVES: To (a) determine early treatment outcomes and (b) assess safety in children treated with adult fixed-dose combination (FDC) antiretroviral tablets. SETTING: Sixteen Medecins Sans Frontieres (MSF) HIV programs in eight countries in resource-limited settings (RLS). METHODS: Analysis of routine program data gathered June 2001 to March 2005. RESULTS: 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. CONCLUSIONS: 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.en
dc.language.isoenen
dc.rightsPublished by Wolters Kluwer Lippincott Williams & Wilkins - Archived on this site by kind permission Wolters Kluweren
dc.subject.meshAfricaen
dc.subject.meshAnti-Retroviral Agentsen
dc.subject.meshAsia, Southeasternen
dc.subject.meshCD4 Lymphocyte Counten
dc.subject.meshChilden
dc.subject.meshChild, Preschoolen
dc.subject.meshDeveloping Countriesen
dc.subject.meshDrug Administration Scheduleen
dc.subject.meshDrug Costsen
dc.subject.meshFemaleen
dc.subject.meshHIV Infectionsen
dc.subject.meshHumansen
dc.subject.meshMaleen
dc.subject.meshSafetyen
dc.subject.meshSurvival Rateen
dc.subject.meshTreatment Outcomeen
dc.titleIn Resource-Limited Settings Good Early Outcomes Can be Achieved in Children Using Adult Fixed-Dose Combination Antiretroviral Therapy.en
dc.contributor.departmentAIDS Working Group, Medecins Sans Frontieres, Plantage Middenlaan 14, 1001 EA Amsterdam, The Netherlands. daniel.obrien@amsterdam.msf.orgen
dc.identifier.journalAIDS (London, England)en
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