Effectiveness of highly active antiretroviral therapy in HIV-positive children: evaluation at 12 months in a routine program in Cambodia.

Hdl Handle:
http://hdl.handle.net/10144/18312
Title:
Effectiveness of highly active antiretroviral therapy in HIV-positive children: evaluation at 12 months in a routine program in Cambodia.
Authors:
Janssens, B; Raleigh, B; Soeung, S; Akao, K; Te, V; Gupta, J; Vun, M; Ford, N; Nouhin, J; Nerrienet, E
Journal:
Pediatrics
Abstract:
OBJECTIVE: Increasing access to highly active antiretroviral therapy to reach all those in need in developing countries (scale up) is slowly expanding to HIV-positive children, but documented experience remains limited. We aimed to describe the clinical, immunologic, and virologic outcomes of pediatric patients with >12 months of highly active antiretroviral therapy in 2 routine programs in Cambodia. METHODS: Between June 2003 and March 2005, 212 children who were younger than 13 years started highly active antiretroviral therapy. Most patients started a standard first-line regimen of lamivudine, stavudine, and nevirapine, using split adult fixed-dosage combinations. CD4 percentage and body weight were monitored routinely. A cross-sectional virologic analysis was conducted in January 2006; genotype resistance testing was performed for patients with a detectable viral load. RESULTS: Mean age of the subjects was 6 years. Median CD4 percentage at baseline was 6. Survival was 92% at 12 months and 91% at 24 months; 13 patients died, and 4 were lost to follow-up. A total of 81% of all patients had an undetectable viral load. Among the patients with a detectable viral load, most mutations were associated with resistance to lamivudine and non-nucleoside reverse-transcriptase inhibitor drugs. Five patients had developed extensive antiretroviral resistance. Being an orphan was found to be a predictor of virologic failure. CONCLUSIONS: This study provides additional evidence of the effectiveness of integrating HIV/AIDS care with highly active antiretroviral therapy for children in a routine setting, with good virologic suppression and immunologic recovery achieved by using split adult fixed-dosage combinations. Viral load monitoring and HIV genotyping are valuable tools for the clinical follow-up of the patients. Orphans should receive careful follow-up and extra support.
Affiliation:
Médecins Sans Frontières, Phnom Penh, Cambodia. b.janssens@bigfoot.com
Issue Date:
Nov-2007
URI:
http://hdl.handle.net/10144/18312
DOI:
10.1542/peds.2006-3503
PubMed ID:
17954553
Language:
en
ISSN:
1098-4275
Appears in Collections:
HIV/AIDS

Full metadata record

DC FieldValue Language
dc.contributor.authorJanssens, B-
dc.contributor.authorRaleigh, B-
dc.contributor.authorSoeung, S-
dc.contributor.authorAkao, K-
dc.contributor.authorTe, V-
dc.contributor.authorGupta, J-
dc.contributor.authorVun, M-
dc.contributor.authorFord, N-
dc.contributor.authorNouhin, J-
dc.contributor.authorNerrienet, E-
dc.date.accessioned2008-02-14T14:27:11Z-
dc.date.available2008-02-14T14:27:11Z-
dc.date.issued2007-11-
dc.identifier.citationEffectiveness of highly active antiretroviral therapy in HIV-positive children: evaluation at 12 months in a routine program in Cambodia. 2007, 120 (5):e1134-40 Pediatricsen
dc.identifier.issn1098-4275-
dc.identifier.pmid17954553-
dc.identifier.doi10.1542/peds.2006-3503-
dc.identifier.urihttp://hdl.handle.net/10144/18312-
dc.description.abstractOBJECTIVE: Increasing access to highly active antiretroviral therapy to reach all those in need in developing countries (scale up) is slowly expanding to HIV-positive children, but documented experience remains limited. We aimed to describe the clinical, immunologic, and virologic outcomes of pediatric patients with >12 months of highly active antiretroviral therapy in 2 routine programs in Cambodia. METHODS: Between June 2003 and March 2005, 212 children who were younger than 13 years started highly active antiretroviral therapy. Most patients started a standard first-line regimen of lamivudine, stavudine, and nevirapine, using split adult fixed-dosage combinations. CD4 percentage and body weight were monitored routinely. A cross-sectional virologic analysis was conducted in January 2006; genotype resistance testing was performed for patients with a detectable viral load. RESULTS: Mean age of the subjects was 6 years. Median CD4 percentage at baseline was 6. Survival was 92% at 12 months and 91% at 24 months; 13 patients died, and 4 were lost to follow-up. A total of 81% of all patients had an undetectable viral load. Among the patients with a detectable viral load, most mutations were associated with resistance to lamivudine and non-nucleoside reverse-transcriptase inhibitor drugs. Five patients had developed extensive antiretroviral resistance. Being an orphan was found to be a predictor of virologic failure. CONCLUSIONS: This study provides additional evidence of the effectiveness of integrating HIV/AIDS care with highly active antiretroviral therapy for children in a routine setting, with good virologic suppression and immunologic recovery achieved by using split adult fixed-dosage combinations. Viral load monitoring and HIV genotyping are valuable tools for the clinical follow-up of the patients. Orphans should receive careful follow-up and extra support.en
dc.language.isoenen
dc.rightsReproduced on this site with kind permission from Pediatrics, Copyright 2007 by the American Academy of Pediatricsen
dc.subject.meshAntiretroviral Therapy, Highly Activeen
dc.subject.meshCambodiaen
dc.subject.meshChilden
dc.subject.meshChild, Preschoolen
dc.subject.meshCross-Sectional Studiesen
dc.subject.meshFemaleen
dc.subject.meshFollow-Up Studiesen
dc.subject.meshHIV Infectionsen
dc.subject.meshHIV Seropositivityen
dc.subject.meshHIV-1en
dc.subject.meshHumansen
dc.subject.meshMaleen
dc.subject.meshViral Loaden
dc.titleEffectiveness of highly active antiretroviral therapy in HIV-positive children: evaluation at 12 months in a routine program in Cambodia.en
dc.contributor.departmentMédecins Sans Frontières, Phnom Penh, Cambodia. b.janssens@bigfoot.comen
dc.identifier.journalPediatricsen

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