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Review
. 2011 Feb;127(2):e423-41.
doi: 10.1542/peds.2009-2701. Epub 2011 Jan 24.

Post-HAART outcomes in pediatric populations: comparison of resource-limited and developed countries

Elizabeth Peacock-Villada  1 , Barbra A Richardson, Grace C John-Stewart
Affiliations
Review

Post-HAART outcomes in pediatric populations: comparison of resource-limited and developed countries

Elizabeth Peacock-Villada et al. Pediatrics. 2011 Feb.

Abstract

Context: No formal comparison has been made between the pediatric post-highly active antiretroviral therapy (HAART) outcomes of resource-limited and developed countries.

Objective: To systematically quantify and compare major baseline characteristics and clinical end points after HAART between resource-limited and developed settings.

Methods: Published articles and abstracts (International AIDS Society 2009, Conference on Retroviruses and Opportunistic Infections 2010) were examined from inception (first available publication for each search engine) to March 2010. Publications that contained data on post-HAART mortality, weight-for-age z score (WAZ), CD4 count, or viral load (VL) changes in pediatric populations were reviewed. Selected studies met the following criteria: (1) patients were younger than 21 years; (2) HAART was given (≥ 3 antiretroviral medications); and (3) there were >20 patients. Data were extracted for baseline age, CD4 count, VL, WAZ, and mortality, CD4 and virologic suppression over time. Studies were categorized as having been performed in a resource-limited country (RLC) or developed country (DC) on the basis of the United Nations designation. Mean percentage of deaths per cohort and deaths per 100 child-years, baseline CD4 count, VL, WAZ, and age were calculated for RLCs and DCs and compared by using independent samples t tests.

Results: Forty RLC and 28 DC publications were selected (N = 17 875 RLCs; N = 1835 DC). Mean percentage of deaths per cohort and mean deaths per 100 child-years after HAART were significantly higher in RLCs than DCs (7.6 vs 1.6, P < .001, and 8.0 vs 0.9, P < .001, respectively). Mean baseline CD4% was 12% in RLCs and 23% in DCs (P = .01). Mean baseline VLs were 5.5 vs 4.7 log(10) copies per mL in RLCs versus DCs (P < .001).

Conclusions: Baseline CD4% and VL differ markedly between DCs and RLCs, as does mortality after pediatric HAART. Earlier diagnosis and treatment of pediatric HIV in RLCs would be expected to result in better HAART outcomes.

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Figures

FIGURE 1
FIGURE 1
Study-selection flowchart. ARV indicates antiretroviral medication.
FIGURE 2
FIGURE 2
Pediatric DPCY after HAART: HAART-naive cohorts. a Includes mono/dual ART-experienced patients. Vertical line (…), DC mean DPCY for HAART-naive studies; vertical line (—), RLC mean DPCY for HAART-naive studies; horizontal lines, 95% confidence intervals for weighted mean.
FIGURE 3
FIGURE 3
CD4 T-cell percentage change over time. A, RLCs; B, DCs.
FIGURE 4
FIGURE 4
Percentage of patients who achieved viral suppression over time. A, RLCs; B, DCs. a Intention-to-treat analysis.
See this image and copyright information in PMC

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