Pediatric HIV Clinical Care Resources and Management Practices in Asia: A Regional Survey of the TREAT Asia Pediatric Network

Abstract

Characterizing intraregional differences in current pediatric HIV care and treatment in Asia can guide the development of clinical practice guidelines and improve the understanding of local resource availability. The Therapeutics Research, Education, and AIDS Training in Asia (TREAT Asia) Pediatric Program is a collaboration of clinics and referral hospitals studying pediatric HIV outcomes in the region. A Web-based survey to characterize clinical management practices and monitoring resources was developed and distributed to 20 sites in January 2008. Seventeen (85%) sites from 6 countries responded through April 2008; 14 (82%) were hospital-based and 16 (94%) were public facilities. Of 4050 HIV-infected children under care, 3606 (89%) were on antiretroviral treatment; 80% were on their first mono-, dual-, or triple-drug regimen and 74% were on nevirapine- or efavirenz-based regimens. Fifteen (88%) sites had consistent access to polymerase chain reaction (PCR) testing for infant diagnosis. All sites had access to CD4 testing, with 13 (76%) routinely monitoring patients every 3-6 months; 7 (41%) sites monitored viral load at 6- to 12-month intervals. Although there is some variation in clinical practices, high levels of treatment and monitoring resources were available at these sites. The availability of PCR for early infant diagnosis positions them to implement recent WHO recommendations to treat HIV-infected children younger than 1 year of age. This information will be used to develop future research and programs to support children with HIV in Asia.

HIV‐1 drug resistance mutations in children after failure of first‐line nonnucleoside reverse transcriptase inhibitor‐based antiretroviral therapy

“…Recently, the National Health Security Office, which provides ART to almost all HIVinfected Thai children, reported that 20% of HIV-infected Thai children are receiving second-line PI regimens. The regional Asian network, Treat Asia, which follows over 1000 children, also reported that 20% of children were on second-line ART [19].The children in our study were from eight large paediatric HIV centres in Thailand. Similar to other studies on children from South Africa [6] and Thailand [8,18], extensive NRTI mutations were found.…”

“…Recently, the National Health Security Office, which provides ART to almost all HIVinfected Thai children, reported that 20% of HIV-infected Thai children are receiving second-line PI regimens. The regional Asian network, Treat Asia, which follows over 1000 children, also reported that 20% of children were on second-line ART [19].…”

Tackling HIV through robust diagnostics in the developing world: current status and future opportunities

“…MTCT can also be prevented by reducing unwanted pregnancies [3]. Pediatric HIV treatments include variations in formula feeding or exclusive breastfeeding [9]. Ultimately, diagnosis of infants during their early stages of life enables them to benefit most from life-saving drug treatments.…”

Antiretroviral Therapy for Children in Resource-Limited Settings

“…A crosssectional survey of 17 sites in six Asian countries completed in April 2008 showed that 20% of 3606 children receiving ART had progressed beyond first-line therapy. [64] A more recent survey that analysed data from 10 Asian and 16 southern African sites showed that 10% of 1301 Asian children and 3.3% of 4561 southern African children had initiated second-line therapy. [65] Switching to second-line therapy in RLS has been constrained by unclear criteria for diagnosing treatment failure, and the inaccuracy of clinical and immunological criteria for identifying children with treatment failure.…”