Antiretroviral Therapy Outcomes of HIV-Infected Children in the TREAT Asia Pediatric HIV Observational Database

Hansudewechakul, Rawiwan; Sirisanthana, Virat; Kurniati, Nia; Puthanakit, Thanyawee; Lumbiganon, Pagakrong; Saphonn, Vonthanak; Yusoff, Nik Khairulddin Nik; Kumarasamy, Nagalingeswaran; Fong, Siew Moy; Nallusamy, Revathy; Srasuebkul, Preeyaporn; Law, Matthew; Sohn, Annette H.; Chokephaibulkit, Kulkanya

doi:10.1097/qai.0b013e3181f5379a

Cited by 41 publications

(46 citation statements)

References 19 publications

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“…Median CD4 + T cell percentage increased from 3.16 (IQR 1-18) % to 11.0 (IQR 2-32) %, whereas median CD4 + absolute cell count increased from 9.5 (IQR 3-176) cell/mm 3 to 419.5 (IQR 202-1428) cell/mm 3 . Baseline level of CD4 + cell count in our study was very low compared with other studies [15,[19][20][21][22], but this result was not much different from baseline levels from 8 sites in Asia [14]. After ART initiation, CD4…”

Section: Discussioncontrasting

confidence: 51%

“…In rural areas which are resource-limited, clinical and immunological parameters can be used as parameters to evaluate ART therapy [12,13]. Immunological response after ART initiation occurs within the first 6 months and this response continues within 3 years thereafter [3,14]. Until now, no data have been reported on immunological responses in HIV-infected children who are treated with first-line ART in Yogyakarta.…”

Section: Introductionmentioning

confidence: 99%

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Immunological outcomes after six months with first line antiretroviral therapy: a lesson from Yogyakarta, Indonesia

Pangarungan¹,

Arguni²

2018

J Infect Dev Ctries

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Introduction: More than 1,300 children aged 0-14 years were infected with HIV in Indonesia by 2016. Adequate antiretroviral therapy (ART) can increase nutritional and immunological status, reduce incidence of opportunistic infection and mortality caused by HIV infection. After ART initiation, the children's treatment response needs to be monitored with CD4 + cell count and Viral Load (VL) evaluation. In resourcelimited setting, clinical and immunological parameters can be used to evaluate ART outcomes. The aimed of this study to know immunological status of the patient after 6 months ART in Dr. Sardjito Hospital in Yogyakarta, Indonesia. Methodology: A retrospective study was conducted from January 2010 to May 2016. HIV-infected children aged 0-18 years who were given first-line ART at least 6 months were included in this study. Age when ART initiation, gender, residence, nutritional status, clinical staging based on WHO criteria, incidence of hospitalization, baseline CD4 + cell count and CD4 + cell count after 6 months of therapy, tuberculosis treatment, and ART regimens were collected from medical records. Data were entered and analyzed using SPSS version 20.0 Results: Thirty-five subjects were included in this study. Median CD4 + T cell percentage increased from 3.16 (IQR 1-18) % to 11.0 (IQR 2-32) %, whereas median CD4 + absolute cell count increased from 9.5 (IQR 3-176) cell/mm 3 to 419.5 (IQR 202-1428) cell/mm 3 . Conclusion: Immunologic conditions could improve even with very low levels of CD4 + T cell percentage and CD4 + absolute cell count. Monitoring immunologic conditions and adherence of children with ART are essential to improve treatment outcomes.

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Section: Discussioncontrasting

confidence: 51%

Section: Introductionmentioning

confidence: 99%

Immunological outcomes after six months with first line antiretroviral therapy: a lesson from Yogyakarta, Indonesia

Pangarungan¹,

Arguni²

2018

J Infect Dev Ctries

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“…Further study of the pathogenesis and immunological correlates of LIP are required to better understand the mechanism of radiological improvement. The ART-related radiographic response in PTB may be achieved through arresting clinical progression of HIV disease,28 29 enhancing immunity30 or increasing the efficacy of TB treatment 11…”

Section: Discussionmentioning

confidence: 99%

Chest radiographic abnormalities in HIV-infected African children: a longitudinal study

Pitcher

Lombard

Cotton

et al. 2015

Thorax

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“…[18] The 1977 standards were used because the WHO 2007 weight-for-age standards are only applicable to children ≤10 years old, and a previous TApHOD analysis found the 1977 and 2007 standards give similar results. [19] Patients were considered hepatitis B co-infected if they had any record of a positive hepatitis B surface antigen test, and hepatitis C co-infected if they had any record of a positive hepatitis C antibody test. Patients were considered to be using cotrimoxazole prophylaxis if they were using cotrimoxazole at ART initiation or if they started within three months of initiating ART.…”

Section: Methodsmentioning

confidence: 99%

Non-Nucleoside Reverse Transcriptase Inhibitor–Based Antiretroviral Therapy in Perinatally HIV-Infected, Treatment-Naïve Adolescents in Asia

Boettiger¹,

Sudjaritruk

Nallusamy

et al. 2016

Journal of Adolescent Health

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Purpose About a third of untreated, perinatally HIV-infected children reach adolescence. We evaluated the durability and effectiveness of non-nucleoside reverse transcriptase inhibitor (NNRTI)-based antiretroviral therapy (ART) in this population. Methods Data from perinatally HIV-infected, antiretroviral-naïve patients initiated on NNRTI-based ART aged 10–19 years who had ≥6 months of follow-up were analyzed. Competing risk regression was used to assess predictors of NNRTI substitution and clinical failure (WHO stage 3/4 event or death). Viral suppression was defined as a viral load <400 copies/ml. Results Data from 534 adolescents met our inclusion criteria (56.2% female; median age at treatment initiation 11.8 years). After five years of treatment, median height-for-age z-score increased from −2.3 to −1.6 and median CD4+ cell count increased from 131 to 580 cells/mm3. The proportion of patients with viral suppression after 6 months was 87.6% and remained >80% up to five years of follow-up. NNRTI substitution and clinical failure occurred at rates of 4.9 and 1.4 events per 100 patient-years, respectively. Not using cotrimoxazole prophylaxis at ART initiation was associated with NNRTI substitution (HR 1.5 versus using, 95%CI 1.0–2.2, p=0.05). Baseline CD4+ count ≤200 cells/mm3 (HR 3.3 versus >200, 95%CI 1.2–8.9, p=0.02) and not using cotrimoxazole prophylaxis at ART initiation (HR 2.1 versus using, 95%CI 1.0–4.6, p=0.05) were both associated with clinical failure. Conclusions Despite late ART initiation, adolescents achieved good rates of catch-up growth, CD4+ count recovery, and virological suppression. Earlier ART initiation and routine cotrimoxazole prophylaxis in this population may help to reduce current rates of NNRTI substitution and clinical failure.

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Antiretroviral Therapy Outcomes of HIV-Infected Children in the TREAT Asia Pediatric HIV Observational Database

Cited by 41 publications

References 19 publications

Immunological outcomes after six months with first line antiretroviral therapy: a lesson from Yogyakarta, Indonesia

Immunological outcomes after six months with first line antiretroviral therapy: a lesson from Yogyakarta, Indonesia

Chest radiographic abnormalities in HIV-infected African children: a longitudinal study

Non-Nucleoside Reverse Transcriptase Inhibitor–Based Antiretroviral Therapy in Perinatally HIV-Infected, Treatment-Naïve Adolescents in Asia

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