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Early response to highly active antiretroviral therapy in HIV-1-infected Kenyan children

Dalton C Wamalwa1, Carey Farquhar, Elizabeth M Obimbo

  • 1Department of Pediatrics, University of Nairobi, Nairobi, Kenya. dalton@africaonline.co.ke

Journal of Acquired Immune Deficiency Syndromes (1999)
|March 16, 2007
PubMed

Insights

Highly active antiretroviral therapy (HAART) using nonnucleoside reverse transcriptase inhibitor (NNRTI)-based regimens showed positive early clinical and virologic responses in Kenyan children with advanced HIV-1 disease. This treatment improved growth, reduced hospitalizations, and increased CD4 counts, demonstrating HAART

Area of Science:

  • Pediatric Infectious Diseases
  • Virology
  • Public Health

Background:

  • The study addresses the critical need for effective first-line antiretroviral therapy in HIV-1-infected children in resource-limited settings.
  • Evaluating the early response to nonnucleoside reverse transcriptase inhibitor (NNRTI)-based highly active antiretroviral therapy (HAART) is crucial for optimizing treatment guidelines.

Purpose of the Study:

  • To assess the early clinical and virologic outcomes of WHO-recommended NNRTI-based HAART in Kenyan children with HIV-1 infection who had not previously received nevirapine.
  • To evaluate the impact of HAART on growth parameters, CD4 counts, and viral load in this pediatric cohort.

Main Methods:

  • An observational prospective cohort study was conducted with 67 HIV-1-infected children.
  • Clinical and laboratory parameters, including HIV-1 RNA levels, CD4 counts, and growth z scores, were monitored before and during HAART treatment.
  • Children received no nutritional supplements during the study period.

Main Results:

  • After 6 months of HAART, significant improvements were observed: median height-for-age z score increased from -2.54 to -2.17 and weight-for-age z score from -2.30 to -1.67.
  • Hospitalization rates decreased significantly from 58% to 17% (P<0.001).
  • Median absolute CD4 count rose from 326 to 536 cells/microL, CD4 percentage increased from 5.8% to 15.4%, and median viral load decreased from 5.9 to 2.2 log10 copies/mL. Viral suppression (<100 copies/mL) was achieved in 47% of infants.

Conclusions:

  • NNRTI-based HAART demonstrates a good early clinical and virologic response in HIV-1-infected Kenyan children with advanced disease.
  • The findings support the use of NNRTI-based HAART as an effective first-line treatment strategy for children in similar settings.
  • Early initiation of HAART leads to significant improvements in immunological status, viral load reduction, and growth parameters.
Abstract

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