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. 2010 Jun;95(6):414-21.
doi: 10.1136/adc.2009.169367. Epub 2009 Oct 29.

Successful paediatric HIV treatment in rural primary care in Africa

N Janssen  1 , J Ndirangu, M-L Newell, R M Bland
Affiliations
Free PMC article

Successful paediatric HIV treatment in rural primary care in Africa

N Janssen et al. Arch Dis Child. 2010 Jun.
Free PMC article

Abstract

Objective: Clinical outcomes of HIV-infected children on antiretroviral treatment (ART) in a decentralised, nurse/counsellor-led programme.

Design: Clinical cohort.

Setting: KwaZulu-Natal, South Africa.

Patients: HIV-infected children aged <or=15 years on ART, June 2004-2008.

Main outcome measures: Survival according to baseline characteristics including age, WHO clinical stage, haemoglobin and CD4%, was assessed in Kaplan-Meier analyses. Hazard ratios for mortality were estimated using Cox proportional hazards regression and changes in laboratory parameters and weight-for-age z scores after 6-12 months' treatment were calculated.

Results: 477 HIV-infected children began ART at a median age of 74 months (range 4-180), median CD4 count (CD4%) of 433 cells/mm(3) (17%) and median HIV viral load of log 4.2 copies/ml; 105 (22%) were on treatment for tuberculosis and 317 (76.6%) were WHO stage 3/4. There were significant increases after ART initiation in CD4% (17% vs 22%; p<0.001), haemoglobin (9.9 vs 11.7 g/l; p<or=0.001) and albumin (30 vs 36 g/l; p<or=0.001). 32 (6.7%) children died over 732 child-years of follow-up (43.7 deaths/1000 child-years; 95% CI 32.7 to 58.2), 17 (53.1%) within 90 days of treatment initiation; median age of death was 84 (IQR 10-181) months. Children with baseline haemoglobin <or=8 g/l were more likely to die (adjusted HR 4.5; 95% CI 1.6 to 12.3), as were those aged <18 months compared with >60 months (adjusted HR 3.2; 95% CI 1.2 to 9.1).

Conclusions: Good clinical outcomes in HIV-infected children on ART are possible in a rural, decentralised service. Few young children are on ART, highlighting the urgent need to identify HIV-exposed infants.

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Conflict of interest statement

Competing interests None.

Figures

Figure 1
Figure 1
Mortality in children receiving antiretroviral therapy by (A) haemoglobin concentration, (B) age, (C) WHO clinical stage and (D) CD4 cell percentage.
See this image and copyright information in PMC

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