Published online September 10, 2007
PEDIATRICS Vol. 120 No. 4 October 2007, pp. e856-e861 (doi:10.1542/peds.2006-1122)
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ARTICLE

Efficacy of Highly Active Antiretroviral Therapy in HIV-1–Infected Children in Kenya

Rinn Song, MDa, Justine Jelagat, MBChBb, Doris Dzombo, RCOb, Marietta Mwalimu, RNb, Kishorchandra Mandaliya, MBChBb, Khadija Shikely, MBChBb and Shaffiq Essajee, MDb,c

a Departments of Pediatrics
c Pediatric Infectious Diseases, New York University, New York, New York
b Family Care Clinic, Coast Province General Hospital, Mombasa, Kenya

OBJECTIVE. Few studies have investigated the efficacy of antiretroviral therapy among HIV-infected children in resource-poor settings. This observational, retrospective analysis describes the clinical, immunologic, and virologic effects of highly active antiretroviral therapy in treatment-naive, HIV-infected children in Mombasa, Kenya. In keeping with a public health approach, all children were treated by using a simplified, nationally approved, triple-drug regimen.

METHODS. Clinical data and stored plasma samples from 29 children who were followed prospectively between April 2003 and October 2004 were analyzed. All children received generic formulations of nevirapine, zidovudine, and lamivudine and were evaluated at baseline and at 3, 6, 9, 12, and 15 months. At each visit, weight and CD4 lymphocyte counts were measured and plasma samples were stored for analysis. HIV RNA load was determined retrospectively at baseline and 9 months after initiation of therapy.

RESULTS. The mean age of the children was 8.5 years (range: 2–16 years). At baseline, the mean CD4 count (±SD) was 182.3 x 106 cells per µL (±145.6). On treatment, CD4 counts increased step-wise by a mean of 187 x 106 cells per µL at 3 months, 293 cells per µL at 6 months, 308 cells per µL at 9 months, 334 cells per µL at 12 months, and 363 cells per µL at 15 months. The mean plasma viral load decreased from a baseline level of 622 712 to 35369 copies per mL, and at 9 months was undetectable in 55% of the patients. Mean z scores for weight for age increased from a baseline of –1.61 to –1.12 at 12 months into therapy.

CONCLUSIONS. A public health approach using 1 treatment regimen in generic form showed excellent efficacy among treatment-naive, HIV-infected children in a resource-limited country. Clinical and immunologic improvement occurred in all patients, but 9 months after the start of therapy, only 55% of the children had an undetectable viral load.

Key Words: HIV-1 • AIDS • HAART • African children • Kenya

Abbreviations: WHO—World Health Organization • ART—antiretroviral therapy • HAART—highly active antiretroviral therapy • CDC—Centers for Disease Control and Prevention

Accepted Feb 7, 2007.