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Post-HAART outcomes in pediatric populations: comparison of resource-limited and developed countries
Elizabeth Peacock-Villada1, Barbra A Richardson, Grace C John-Stewart
1University of Washington School of Medicine, Seattle, Washington 98195-6340, USA. lilipv@u.washington.edu
Insights
Pediatric outcomes after highly active antiretroviral therapy (HAART) show significantly higher mortality in resource-limited countries compared to developed countries, indicating a need for earlier HIV diagnosis and treatment.
Area of Science:
- Pediatric infectious diseases
- Global health equity
- HIV/AIDS research
Background:
- Outcomes of pediatric highly active antiretroviral therapy (HAART) have not been formally compared between resource-limited countries (RLCs) and developed countries (DCs).
- Understanding these differences is crucial for improving global pediatric HIV/AIDS management.
Purpose of the Study:
- To systematically quantify and compare baseline characteristics and clinical outcomes after HAART in pediatric populations between RLCs and DCs.
- To identify disparities in HAART effectiveness based on geographical resource availability.
Main Methods:
- A systematic review of published articles and conference abstracts (up to March 2010) on pediatric HAART outcomes.
- Data extraction included mortality, weight-for-age z score (WAZ), CD4 count, and viral load (VL) changes.
- Studies were categorized as RLC or DC based on UN designation; statistical comparisons were made using independent samples t tests.
Main Results:
- Forty RLC and 28 DC publications were analyzed (N = 17,875 RLCs; N = 1,835 DCs).
- Mean mortality rates (per cohort and per 100 child-years) were significantly higher in RLCs than DCs (P < .001).
- RLCs showed lower mean baseline CD4% (12% vs 23%, P = .01) and higher mean baseline VL (5.5 vs 4.7 log10 copies/mL, P < .001) compared to DCs.
Conclusions:
- Significant differences exist in baseline CD4% and viral load, as well as post-HAART mortality, between pediatric HIV patients in RLCs and DCs.
- Earlier diagnosis and initiation of HAART in RLCs are likely to improve clinical outcomes.
- Addressing resource disparities is essential for optimizing pediatric HIV care globally.
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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