Published online October 22, 2007
PEDIATRICS Vol. 120 No. 5 November 2007, pp. e1134-e1140 (doi:10.1542/peds.2006-3503)
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ARTICLE

Effectiveness of Highly Active Antiretroviral Therapy in HIV-Positive Children: Evaluation at 12 Months in a Routine Program in Cambodia

Bart Janssens, MDa, Brian Raleigh, MBBS, DTM&H, DipObsa, Seithaboth Soeung, MDb, Kazumi Akaob, Vantha Te, MDc, Jitendra Gupta, MDa, Mean Chhy Vun, MDd, Nathan Ford, BSce, Janin Nouhinf and Eric Nerrienet, PhDf

a Médecins Sans Frontières, Phnom Penh, Cambodia
b Department of Infectious Diseases, Angkor Hospital for Children, Siem Reap, Cambodia
c Department of Pediatrics, Takeo Referral Hospital
d National Center of HIV/AIDS and Dermatology and STDs, Ministry of Health, Phnom Penh, Cambodia
e Médecins Sans Frontières, Bangkok/HIV/Hepatitis Laboratory, Thailand
f Institut Pasteur, Cambodia, Phnom Penh, Cambodia

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.

Key Words: HIV • children • Cambodia • HAART • viral load • genotyping

Abbreviations: HAART—highly active antiretroviral therapy • WHO—World Health Organization • MSF—Médecins Sans Frontières • CI—confidence interval • IQR—interquartile range • NRTI—nucleoside reverse-transcriptase inhibitor • NNRTI—non–nucleoside reverse-transcriptase inhibitor • FDC—fixed-dosage combination

Accepted Mar 16, 2007.


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