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Effect of antiretroviral therapy in human immunodeficiency virus-infected children

Pimpanada Chearskul1, Kulkanya Chokephaibulkit, Sanay Chearskul

  • 1Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand. pimpanada@hotmail.com

Journal of the Medical Association of Thailand = Chotmaihet Thangphaet
|July 22, 2006
PubMed

Insights

Starting antiretroviral (ARV) therapy for children with human immunodeficiency virus (HIV) at a CD4 count above 15% improves survival. Highly active antiretroviral therapy (HAART) also shows survival benefits, particularly for those with lower baseline CD4 counts.

Area of Science:

  • Pediatric Infectious Diseases
  • HIV/AIDS Clinical Research
  • Immunology

Background:

  • Optimal timing for antiretroviral (ARV) therapy initiation in pediatric HIV infection remains unclear.
  • Adult studies suggest poorer outcomes with lower baseline CD4 counts, but early treatment poses challenges in resource-limited settings.
  • Concerns exist regarding long-term side effects and adherence with early ARV initiation.

Purpose of the Study:

  • To evaluate the clinical outcomes of HIV-infected children based on the stage of ARV treatment initiation.
  • To compare survival rates and CD4 cell count responses across different ARV treatment strategies and disease stages.

Main Methods:

  • Retrospective review of medical records for HIV-infected children treated at Siriraj Hospital.
  • Analysis of clinical response and outcome data from 200 patients followed between September 1996 and March 2004.
  • Comparison of outcomes based on baseline CD4 cell count percentage and type of ARV regimen (monotherapy/dual NRTI vs. HAART).

Main Results:

  • Patients initiated on HAART showed a trend towards better survival compared to dual NRTI regimens (p=0.2377).
  • Survival rates were significantly better for children initiating ARV treatment with a baseline CD4 percentage of >= 15% versus < 15% (p=0.0471).
  • The median age at treatment initiation was 38 months, with a median follow-up of 26 months.

Conclusions:

  • Initiating ARV treatment in children with HIV at a CD4 percentage > 15% is associated with improved survival.
  • Highly active antiretroviral therapy (HAART) regimens appear to enhance survival and CD4 count gains, especially in patients with lower baseline CD4 percentages (< 15%).
Abstract

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