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    Jan 17, 2021
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    Effectiveness of highly active antiretroviral therapy in HIV-positive children: evaluation at 12 months in a routine program in Cambodia.

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    Authors
    Janssens, B
    Raleigh, B
    Soeung, S
    Akao, K
    Te, V
    Gupta, J
    Vun, M
    Ford, N
    Nouhin, J
    Nerrienet, E
    Affiliation
    Médecins Sans Frontières, Phnom Penh, Cambodia. b.janssens@bigfoot.com
    Issue Date
    2007-11
    
    Metadata
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    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.
    URI
    http://hdl.handle.net/10144/18312
    DOI
    10.1542/peds.2006-3503
    PubMed ID
    17954553
    Language
    en
    ISSN
    1098-4275
    ae974a485f413a2113503eed53cd6c53
    10.1542/peds.2006-3503
    Scopus Count
    Collections
    HIV/AIDS

    entitlement

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