Children doing just as well as adults on HIV treatment in southern Africa

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Treatment for children in southern Africa approaches success rates seen in adults, according to data from Baylor International Pediatric AIDS Initiative’s (BIPAI) Network of Children’s Centres of Excellence (COE) in Lesotho, Malawi and Swaziland.

These findings showed mortality rates were reduced by over 50%, decreasing progressively with length of treatment from 10.1 to 4.7% (p<0.01) after one year, researchers reported on Tuesday July 20th at the Eighteenth International AIDS Conference in Vienna.

Good treatment outcomes, defined as increases in CD4 count of more than 5% in children under five and more than 50 CD4 cells/mm3 in children aged 5 to 12, were achieved in 69.1%, 74.6% and 84.2% of children (p.<0.05) in Lesotho, Malawi and Swaziland, respectively, according to Richard Sebastian Wanless who presented the results of this retrospective study.

Glossary

retrospective study

A type of longitudinal study in which information is collected on what has previously happened to people - for example, by reviewing their medical notes or by interviewing them about past events. 

paediatric

Of or relating to children.

fixed-dose combination (FDC)

Two or more drugs contained in a single dosage form, such as a capsule or tablet. By reducing the number of pills a person must take each day, fixed-dose combination drugs may help improve adherence.

cost-effective

Cost-effectiveness analyses compare the financial cost of providing health interventions with their health benefit in order to assess whether interventions provide value for money. As well as the cost of providing medical care now, analyses may take into account savings on future health spending (because a person’s health has improved) and the economic contribution a healthy person could make to society.

CD4 cells

The primary white blood cells of the immune system, which signal to other immune system cells how and when to fight infections. HIV preferentially infects and destroys CD4 cells, which are also known as CD4+ T cells or T helper cells.

The proportion of children with HIV who are on antiretroviral treatment in resource-poor settings is low. The researchers believe this partly explains the absence of paediatric programme evaluations.

While much remains to be done, good progress has been made. According to the World Health Organization (WHO), an estimated 38% of children eligible for treatment were receiving it by the end of 2008, up from 10% in 2005. In Lesotho, where an estimated 15% of all those infected with HIV are children, children represent only 7.4% of those who have started treatment. In Swaziland, 47% of all deaths among children under five are attributable to HIV. In both Swaziland and Malawi the estimated proportion of children on ART is 10%.

The researchers undertook a retrospective study using data from programmes in the three Children’s Centers of Excellence in Lesotho, Malawi and Swaziland.

Baylor International Pediatric AIDS Initiative works in collaboration and partnership with the ministries of health and non-governmental organisations in each of the countries. In Malawi they also work with the Abbott Fund, and in Swaziland and Lesotho with Bristol Myers Squibb’s Secure the Future initiative.

Data were analysed for all HIV-infected children under the age of 12 (2306) who had started antiretroviral treatment and were followed for a year. Annualised mortality rates were calculated from February 2008 to September 2009. Seventy-eight per cent of all deaths occurred within the first few months of treatment. Increased risks for mortality, Dr. Wanless noted, included being under one year of age, having a WHO stage 4 disease, and being severely malnourished.

Children and infants responded well to treatment. The simplification and cost-effectiveness of fixed-dose combinations (FDCs) and use of WHO’s simple weight band dosing tables contributes to scale-up, countering difficulties sometimes associated with a public health approach to treatment.

These results show that with a public health approach to paediatric HIV treatment in resource-poor settings, low mortality and good treatment outcomes are possible. The critical component is getting children onto treatment early enough and keeping them on treatment and in care.

Further information

Richard Sebastian Wanless's presentation and related abstract is avaliable on the official conference website.

References

Wanless RS et al. Mortality and ART efficacy outcomes in children <12 years on ART in Lesotho, Swaziland and Malawi. Eighteenth International AIDS Conference, Vienna, abstract TUPDB202, 2010.