Outcome of highly active antiretroviral therapy in HIV- infected Indian children

Mukherjee, Aparna; Shah, Nipam; Singh, Ravinder; Vajpayee, Madhu; Kabra, S. K.; Lodha, Rakesh

doi:10.1186/s12879-014-0701-2

Cited by 13 publications

(11 citation statements)

References 22 publications

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“…Specifically, the HAZ at both ART initiation and follow up was found to be positively correlated with the CD4 percentage at follow up. Similar reports have been published thus far for adults and older children [25, 28, 29]. …”

Section: Discussionsupporting

confidence: 88%

Anthropometric Improvement among HIV Infected Pre-School Children Following Initiation of First Line Anti-Retroviral Therapy: Implications for Follow Up

et al. 2016

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BackgroundAntiretroviral therapy (ART) is a lifesaving intervention for HIV infected children. There is a scarcity of data on immunological recovery and its relation with growth indicators among HIV infected young children. The current study aims to assess the pattern of anthropometric Z-score improvement following initiation of first-line ART among under-five children and the relationship between anthropometric Z-score improvement and immunologic recovery.MethodsWe included under-five children who were on first-line ART at five major hospitals in Addis Ababa, Ethiopia. We measured anthropometry and collected clinical and laboratory data at follow up, and we retrieved clinical and anthropometric data at ART initiation from records. Z-scores for each of the anthropometric indices were calculated based on WHO growth standards using ENA for SMART 2011 software. Linear regression was used to assess the relationship between time on ART and anthropometric Z-score improvement; and the relationship between anthropometric Z-score improvement and immunologic recovery. Multiple linear regression was used to assess the independent predictors of anthropometric Z-score change.ResultsThe median age of the participants was 4.1 (Interquartile range (IQR): 3.3–4.9) years. More than half (52.48%) were female. The median duration of follow up was 1.69 (IQR: 1.08–2.63) years. There was a significant improvement in all anthropometric indices at any follow up after initiation of first-line ART (underweight; 39.5% vs16.5%, stunting; 71.3% vs 62.9% and wasting; 16.3% vs 1.0%; p-value< 0.0001). There was an inverse relationship between improvement in weight for age Z-score (WAZ) and duration of ART (R2 = 0.04; F (1, 158); p = 0.013). Height for age Z-score (HAZ) both at the time of ART initiation and follow up has a positive linear relationship with CD4 percentage at follow up (Coef. = 1.92; R2 = 0.05; p-value = 0.002). Duration on ART (Std. Err. = 0.206, t = -1.99, p-value = 0.049) and level of maternal education (Std. Err. = 0.290, t = 2.64, p-value = 0.009) were the only independent predictors of the change in WAZ and change in HAZ at any follow up visit respectively.ConclusionThere was a significant improvement in all anthropometric indices at any follow-up after initiation of first-line ART among under-five children. HAZ was linearly related with immunologic recovery following ART initiation. The findings indicate that anthropometric indices could be taken as proxy indicators of immunologic recovery for under-five children.

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Section: Discussionsupporting

confidence: 88%

Anthropometric Improvement among HIV Infected Pre-School Children Following Initiation of First Line Anti-Retroviral Therapy: Implications for Follow Up

et al. 2016

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“…Having a short duration of follow-up, advanced WHO stage at follow up visit, ART non-adherence, and TB at baseline was found to be independent predictors of first-line ART treatment failure. In this study, the median survival time was 57.7 months (95% CI 54.83, 59.77) which is longer than the findings of studies in India; 43 months, 26 a combined study in Mozambique and Uganda; 12.6 months 27 and Uganda; 26.4 months. 28 This could be explained by the improvements in the therapeutic and diagnostic measures in current visits from then and the increase in access and variety of more potent drugs nowadays than the past periods.…”

Section: Discussioncontrasting

confidence: 70%

<p>Incidence and Predictors of Treatment Failure Among Children Receiving First-Line Antiretroviral Treatment in General Hospitals of Two Zones, Tigray, Ethiopia, 2019</p>

Sibhat

Kassa

Gebrehiwot

2020

PHMT

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Background: Despite many efforts undertaken to control the human immunodeficiency virus epidemic, it remains to be the major global public health challenge. With expanding access to pediatric antiretroviral therapy, children are more likely to experience treatment failure. All previous studies conducted in Ethiopia estimated treatment failure using only clinical and CD4 criteria. Thus, the ART failure rate is expected to be underestimated in our country. Objectives of the Study: To assess the incidence and predictors of treatment failure among children receiving first-line ART in general hospitals of Mekelle and Southern Zones of Tigray region, Ethiopia, 2019. Methods: Retrospective follow up study was employed. The sample size was estimated based on a Log rank test using Stata V-13 and all 404 charts were taken for review. Data were collected by extraction tool; entered using Epi-data manager; cleaned and analyzed by Stata V-14. Data were described using the Kaplan-Meier curve, Log rank test, life table, and crude hazard ratios and analyzed using adjusted hazard ratios and p-value by Cox proportional hazard regression. Any variable at P <0.05 in the bi-variable analysis was taken to multi-variate analysis and significance was declared at P≤ 0.05. Data were presented using tables, charts, and texts. Results: The incidence rate of ART failure was 8.68 (95% CI 7.1 to 10.6) per 1000 person-month observations with a total of 11,061.5 person-month observations. Children who had tuberculosis at baseline [AHR=2.27; 95% CI 1.12-4.57], advanced recent WHO stage [AHR=5.21; 95% CI 2.75-9.88] and sub-optimal ART adherence [AHR=2.84, 95% CI 1.71-4.72] were at higher hazard for first-line treatment failure. Besides this having a long duration of ART follow up [AHR=0.85; 95% CI 0.82-0.87] was found to be protective against treatment failure. Conclusion and Recommendation: The incidence of first-line ART failure was grown as a major public health concern. Treatment failure was predicted by the duration of follow up, advanced recent WHO stage, sub-optimal adherence, as well as the presence of tuberculosis at baseline. Hence, it is better to give priority for strengthening the focused evaluation of the WHO clinical stage and tuberculosis co-infection at baseline with continuous adherence monitoring.

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“…Since the discovery of highly active anti-retroviral therapy (HAART), there has been improvement in virology findings, thus HIV-1-infected children can grow and thrive properly [8][9][10]. Survival rate against HIV are increasing in children worldwide and it improves the quality of life in HIV-1-infected children [9][10][11][12][13][14][15][16][17].…”

Section: Resultsmentioning

confidence: 99%

“…Various studies have shown the long-term outcomes of children receiving antiretroviral therapy [8][9][10][17][18][19] but there are no reports on the successful treatment of HIV-1infected children in Indonesia. It is not easy to get an overview about the therapy efficacy in Indonesia, where only less than half of patients had a good adherence to therapy.…”

Section: Resultsmentioning

confidence: 99%

Long-term outcome in fully treated HIV-infected children in West Java-Indonesia: gender differences

Alam¹,

Sumantri²,

Parwati³

et al. 2018

HIV & AIDS Review

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Introduction: Since the discovery of highly active anti-retroviral therapy (HAART), there is an improvement in virology findings, thus human immunodeficiency virus type 1 (HIV-1)-infected children can grow and thrive properly. Studies have showed successful treatments of HIV-1-infected children in limited resources are differed by gender. Material and methods: We enrolled children 2-< 15 years old, vertically transmitted, with good treatment adherence and condition, and minimal therapy duration of 6 months. The study has been approved by the Research and Ethics Committee. Results: One hundred and sixty-eight children were enrolled, 99 were excluded because of lack of adherence and loss to follow-up. As many as 70 children have met the inclusion criteria, 40 (57.1%) children were females, who started anti-retroviral therapy (ART) therapy at the median age of 8 (range, 2.0-14.0 years). When the therapy started, 45 (64.3%) children were moderately to severely symptomatic (WHO stage 3 or 4), and most of them were males. Meanwhile, boys had higher improvement outcome of CD4 with median 10.5% (r = 3-45.7; p = 0.030) and lower viral loads than girls, although all HIV viruses were detected below 20 copy/ml. There was no significant relevance between caregiver and the treatment success. Conclusions: Children in limited resources, especially boys, can achieve successful therapeutic outcome with good treatment adherence and taking medication regardless of the caregiver.

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Outcome of highly active antiretroviral therapy in HIV- infected Indian children

Cited by 13 publications

References 22 publications

Anthropometric Improvement among HIV Infected Pre-School Children Following Initiation of First Line Anti-Retroviral Therapy: Implications for Follow Up

Anthropometric Improvement among HIV Infected Pre-School Children Following Initiation of First Line Anti-Retroviral Therapy: Implications for Follow Up

<p>Incidence and Predictors of Treatment Failure Among Children Receiving First-Line Antiretroviral Treatment in General Hospitals of Two Zones, Tigray, Ethiopia, 2019</p>

Long-term outcome in fully treated HIV-infected children in West Java-Indonesia: gender differences

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