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There is little data on responses to combination antiretroviral therapy (cART) among HIV-infected children in the West African region. We describe treatment outcomes among HIV-1 and HIV-2 infected children initiating cART in a research clinic in The Gambia, West Africa.
All treatment naive HIV-infected children who initiated cART according to the WHO ART guidelines for children between October 2004 and December 2009 were included in the analysis. Kaplan-Meir estimates and sign-rank test were used to investigate the responses to treatment.
65 HIV-1 and five HIV-2 infected children aged<15years were initiated on cART over this time period. HIV-1 infected children were treated with a combination of Zidovudine or Stavudine+Lamivudine+Nevirapine or Efavirenz while children with HIV-2 were treated with Zidovudine+Lamivudine+ritonavir-boosted Lopinavir. HIV-1 infected children were followed-up for a median (IQR) duration of 20.1months (6.9 – 34.3), with their median (IQR) age at treatment initiation, CD4% and plasma viral load at baseline found to be 4.9years (2.1 – 9.1), 13.0% (7.0 – 16.0) and 5.4 log10 copies/ml (4.4 – 6.0) respectively. The median age at treatment initiation of the five HIV-2 infected children was 12years (range: 4.6 – 14.0) while their median baseline CD4+ T cell count and HIV-2 viral load were 140 cells/mm3 (Range: 40 – 570 cells/mm3) and 4.5 log10copies/mL (Range: 3.1 - 4.9 log10copies/mL) respectively.
Among HIV-1 infected children <5years of age at ART initiation, the median (IQR) increases in CD4% from baseline to 12, 24 and 36months were 14% (8 – 19; P=0.0004), 21% (15 – 22; P=0.005) and 15% (15 – 25; P=0.0422) respectively, while the median (IQR) increase in absolute CD4 T cell count from baseline to 12, 24 and 36months for those ≥5years at ART initiation were 470 cells/mm3 (270 – 650; P=0.0005), 230 cells/mm3 (30 – 610; P=0.0196) and 615 cells/mm3 (250 – 1060; P=0.0180) respectively. The proportions of children achieving undetectable HIV-1 viral load at 6-, 12-, 24- and 36months of treatment were 24/38 (63.2%), 20/36 (55.6%), 8/22 (36.4%) and 7/12 (58.3%) respectively. The probability of survival among HIV-1 infected children after 12months on ART was 89.9% (95% CI 78.8 – 95.3). CD4 T cell recovery was sub-optimal in all the HIV-2 infected children and none achieved virologic suppression. Two of the HIV-2 infected children died within 6months of starting treatment while the remaining three were lost to follow-up.
The beneficial effects of cART among HIV-1 infected children in our setting are sustained in the first 24months of treatment with a significant improvement in survival experience up to 36months; however the outcome was poor in the few HIV-2 infected children initiated on cART.