Efficacy of Highly Active Antiretroviral Therapy in HIV-Infected Children Participating in Thailand's National Access to Antiretroviral Program

Puthanakit, Thanyawee; Oberdorfer, Aurmporn; Akarathum, Noppadon; Kanjanavanit, Suparat; Wannarit, Pornphun; Sirisanthana, Thira; Sirisanthana, Virat

doi:10.1086/430714

Cited by 132 publications

(104 citation statements)

References 20 publications

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“…The outcomes in this study generally also compare favorably with the published cohort studies in other resourcelimited contexts such as Thailand, Romania, and Ivory Coast. 8,10,11 The majority of patients in our cohort were treated with split adult FDC of 2 NRTIs and 1 NNRTI, confirming other findings that good outcomes can be achieved with this treatment strategy. 18,19 It should be noted, however, that this practice is a suboptimal interim strategy 13 pending prequalification of pediatric formulations of FDCs.…”

Section: Discussionsupporting

confidence: 83%

“…2 In the West, good outcomes are achieved for children who are on highly active antiretroviral therapy (HAART), [3][4][5][6][7] and studies indicate that similar outcomes can be achieved in resource-limited settings. [8][9][10][11] However, documented experience of treating large numbers of children remains limited.…”

Section: Methods Between June 2003 and March 2005mentioning

confidence: 99%

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Effectiveness of Highly Active Antiretroviral Therapy in HIV-Positive Children: Evaluation at 12 Months in a Routine Program in Cambodia

Janssens¹,

Raleigh²,

Soeung

et al. 2007

Pediatrics

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OBJECTIVE. Increasing access to highly active antiretroviral therapy to reach all those in need in developing countries (scale up) is slowly expanding to HIV-positive children, but documented experience remains limited. We aimed to describe the clinical, immunologic, and virologic outcomes of pediatric patients with >12 months of highly active antiretroviral therapy in 2 routine programs in Cambodia. METHODS. Between June 2003 and March 2005, 212 children who were younger than 13 years started highly active antiretroviral therapy. Most patients started a standard first-line regimen of lamivudine, stavudine, and nevirapine, using split adult fixed-dosage combinations. CD4 percentage and body weight were monitored routinely. A cross-sectional virologic analysis was conducted in January 2006; genotype resistance testing was performed for patients with a detectable viral load. RESULTS. Mean age of the subjects was 6 years. Median CD4 percentage at baseline was 6. Survival was 92% at 12 months and 91% at 24 months; 13 patients died, and 4 were lost to follow-up. A total of 81% of all patients had an undetectable viral load. Among the patients with a detectable viral load, most mutations were associated with resistance to lamivudine and non–nucleoside reverse-transcriptase inhibitor drugs. Five patients had developed extensive antiretroviral resistance. Being an orphan was found to be a predictor of virologic failure. CONCLUSIONS. This study provides additional evidence of the effectiveness of integrating HIV/AIDS care with highly active antiretroviral therapy for children in a routine setting, with good virologic suppression and immunologic recovery achieved by using split adult fixed-dosage combinations. Viral load monitoring and HIV genotyping are valuable tools for the clinical follow-up of the patients. Orphans should receive careful follow-up and extra support.

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Section: Discussionsupporting

confidence: 83%

Section: Methods Between June 2003 and March 2005mentioning

confidence: 99%

Effectiveness of Highly Active Antiretroviral Therapy in HIV-Positive Children: Evaluation at 12 Months in a Routine Program in Cambodia

Janssens¹,

Raleigh²,

Soeung

et al. 2007

Pediatrics

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“…Successful virological response has been reported variously, as < 50 [15,23], < 400 [16,21,24] or < 1000 copies/mL [25] in different parts of the world. Based on these cut-offs, response rates of 55% (two months) in China [24] , 74% in Cambodia [16], and 69% (three months) and 70% (two years) in Thailand have been reported [15].…”

Section: Discussionmentioning

confidence: 99%

“…Lower morbidity has been studied in several pediatric antiretroviral clinical trials as using composite endpoints, such as time to opportunistic infection [11], neurologic deterioration [12], and poor weight growth velocity (three consecutive months with less than the third percentile for age-and genderspecific six-month weight growth velocity) on incremental curves [13] in several pediatric antiretroviral clinical trials. Though reports from developing countries show growth impact in terms of WAZ (by about 1 SD from -2 SD or below at baseline) [14], HAZ and/or WHZ and BMIZ [15][16][17][18], HAZ and WAZ may be more appropriate because in HIVinfected children, the disease itself adversely affects growth in a manner which is symmetrical, with equal effects on weight and height [19,20]. This is in contrast to non-HIV malnutrition where WHZ is more appropriate because the most common pattern of growth is weight loss relative to height for age, followed by declines in height for age, and finally slowed head circumference growth.…”

Section: Introductionmentioning

confidence: 91%

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Clinical manifestations and treatment outcomes in HIV-1-infected children receiving antiretroviral therapy in Karachi, Pakistan

Mir

Qamar

Baig‐Ansari

et al. 2014

J Infect Dev Ctries

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Introduction: The impact of antiretroviral (ARV) therapy on immunological and growth parameters in HIV-positive children in Pakistan has not been reported to date. Methodology: A retrospective chart review of children diagnosed with HIV at the Sindh AIDS Control Proigramme (SACP) and registered at the Aga Khan University, Karachi, between January 2005 and 2013 was conducted, evaluating clinical and laboratory profiles of HIV+ ARV+ children for ARV impact (serial height and weight CD4 and viral counts). Results: Twenty-four children were diagnosed and registered as HIV positive over five years, and 20 were started on ARV. Six were excluded from analysis (ARV duration < 6 months). Nine (64.3%) of 14 fulfilled WHO criteria for treatment failure at a median duration of 25 weeks (IQR 18-32) on ARV and underwent resistance genotyping. All nine had NNRTI resistance, two had high-grade NRTI resistance (≥ 4 thymidine analog mutations). Median age at start of ARV was 71.5 weeks (IQR 37.5-119). Median baseline weight for age (WAZ) and height for age (HAZ) z-scores changed from -1.94 to 1.69 and -1.99 to -1.59, respectively, after six months of therapy. Median CD4 percentage and viral load at baseline changed from 13.8 to 17.8, while viral load changed from 285 × 10 4 copies to zero at six months. Conclusions: ARV improved absolute CD4 and viral counts. Weight and height did not improve significantly, highlighting the need for aggressive nutritional rehabilitation. Early development of ARV resistance in these children requires formal assessment.

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Thai Dental Practitioners’ Knowledge and Attitudes Regarding Patients with HIV

Rungsiyanont

Lam‐ubol

Vacharotayangul

et al. 2013

Journal of Dental Education

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To investigate the knowledge and attitudes of Thai dental practitioners regarding patients with HIV, a cross-sectional study using self-administered questionnaires was conducted. The questionnaires requested demographic information and included questions evaluating the knowledge and attitude of dental practitioners towards HIV. The results were analyzed using Scheffe method for multiple comparisons at the 95 percent conidence level. Out of 1,200 questionnaires sent, 446 questionnaires were returned (response rate 37.2 percent). The subjects included inal (sixth)-year dental students (11.9 percent), general dentists (29.

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Efficacy of Highly Active Antiretroviral Therapy in HIV-Infected Children Participating in Thailand's National Access to Antiretroviral Program

Abstract: In this resource-limited setting, HAART is safe and effective for HIV-infected children despite initiation of treatment during the advanced stage of disease. The use of generic and nonpediatric drug formulations is feasible.

Cited by 132 publications

References 20 publications

Effectiveness of Highly Active Antiretroviral Therapy in HIV-Positive Children: Evaluation at 12 Months in a Routine Program in Cambodia

Effectiveness of Highly Active Antiretroviral Therapy in HIV-Positive Children: Evaluation at 12 Months in a Routine Program in Cambodia

Clinical manifestations and treatment outcomes in HIV-1-infected children receiving antiretroviral therapy in Karachi, Pakistan

Thai Dental Practitioners’ Knowledge and Attitudes Regarding Patients with HIV

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