Clinico-immunological profile and outcome of antiretroviral therapy in HIV-positive children (original) (raw)
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Journal of Tropical Pediatrics, 2008
The objective of this article is to study the survival pattern and the prognostic factors for HIV-infected children on antiretroviral therapy (ART) for two and half years at the Government Hospital of Thoracic Medicine, Tambaram, Chennai, India. We studied 295 children who were initiated on ART from 1 April 2004 to 30 September 2006 at a large, public tertiary care facility in Chennai, India. Weight for age Z-score was calculated. Survival curves and Cox proportional hazard models were used to identify risk factors for mortality. The mean and median follow up was 11 and 10 months, respectively. The cumulative survival probability at 6, 12, 18, 24 and 30 months was 93, 90, 89.7, 89.7 and 89.7%, respectively. Of the children who died, about 50% died within the first month. Nearly 6% of the children had adherence less than 95%. The children who had a baseline CD4 percent less than or equal to 14% had significantly (p < 0.05) higher mortality as compared to children who had 20% or more. The children who had negative or no change in weight for age Z-score and hemoglobin had 18.9 (3.7-95.7) times significantly higher mortality as compared to children who had positive change in both variables (p < 0.001). The sensitivity, specificity and likelihood ratio of the positive test for negative change or no change in HB was 65%, 85% and 4.3, respectively. Similarly, these were 80%, 73% and 3% for negative or no change in Absolute Lymphocyte Count (ALC). These findings indicate the feasibility and effectiveness of implementing an ART program in a large government hospital in India. Simple nutritional variable hemoglobin and immunologic variable ALC could be used to monitor the progression of disease in children.
Ethiopian Journal of Health Sciences, 2011
BACKGROUND: The nature of human immunodeficiency virus infection in children has changed from an often fatal to a treatable chronic condition with highly active antiretroviral therapy. The outcome of the therapy depends on multiple factors such as non-adherence to treatment, selection of resistant viral strains, drug toxicity and socioeconomic factors. The objective of this study was to determine the immunologic and clinical outcomes of children who are on highly active antiretroviral therapy at the ART clinic, Jimma University Specialized Hospital. METHOD: A three-year's retrospective cohort analysis was conducted in July 2008 among children younger than 14 years of age getting highly active antiretroviral therapy in Jimma University Specialized Hospital. Data was collected using a pre-tested record review format and analyzed using SPSS for Windows version 16.0 and World Health Organization Anthro v2.0.2 software. RESULT: Fifty three (55.2%) of the 96 patients were female, the mean age at initiation of treatment was 6 ± 4.2 years and the mean follow-up period was 13.7 ± 8 months. By the time of the study, 69 (71.9 %) patients were still on follow-up, 7 (7.3%) had died, 13 (13.5%) were lost to follow-up and the remaining 7(7.3%) were transferred-out. Majority (93.8%) of them were at WHO stage 3&4 during initiation of treatment. Median Weight-forage Z-score improved from 0.09 to 0.26 after 6 month of treatment. Immunologic treatment failure was seen in 11(11.5%) of the patients; 5 of them also manifested clinical treatment failure. Severe drug toxicity occurred in 5 (5.2%) cases. Presence of chronic gastroenteritis, WHO clinical stage 4 at initiation and appearance of new opportunistic infection after starting treatment were associated with immunologic treatment failure (p <0.03). CONCLUSION: Majority of the patients were having advanced clinical stage at initiation of treatment. Mortality rate and anthropometric changes of HIV infected children on highly active antiretroviral therapy were similar but immunologic treatment failure, loss to follow-up and severe drug toxicity were higher in this study compared to other reports from developing countries. Therefor, early diagnosis and treatment of HIV/AIDS and treatment monitoring should be strengthened.
Effect of Antiretroviral Therapy in Human Immunodeficiency Virus-infected Children
2005
. There was evidence of poorer outcome in adults who initiated treatment at lower baseline CD4 cell count. However, early initiation may not be possible in resource-limited setting and would increased risk of long term side effects and non-adherence. Objective: To elucidate the outcome of HIV-infected children who ARV treatment was initiated at different disease stages. Material and method: Data from medical records of HIV-infected children who had been followed at Infectious Disease Division, Department of Pediatric Siriraj Hospital were retrospectively reviewed. Clinical response and outcome data were analyzed. Results: From September 1996 to March 2004, there were 200 patients with a median age at treatment initiation of 38 (2-175) months. The median duration of follow up period was 26 (1-91) months. The median baseline CD4 cell count was 545 (2-5016) cells/mm 3 . The median baseline CD4 percentage was 14.25 (0.11-60). Monotherapy or dual nucleoside reverse transcriptase inhibitor (NRTI) regimens were initiated in 134 (67%), and HAART was initiated in 66 (33%) patients. The survival rate in patients who initiated with HAART tended to be better than those initiated with dual NRTI regimens but salvaged appropriately (p=0.2377). The survival rate in those initiated treatment at baseline CD4 >15% was better than those initiated at baseline CD4 < 15% (p=0.0471). Conclusion: Initiation of ARV treatment at CD4 more than 15% resulted in a better survival rate than at CD4 below 15%. Initiation with HAART regimen tended to improve survival and resulted in higher CD4 gain especially in cases with baseline CD4< 15%.
Clinical profile and natural history of children with HIV infection
The Indian Journal of Pediatrics, 2006
Objective : As the HIV infection spreads in India, increasing number of children are affected. We report the clinical manifestations, the laboratory parameters and follow up of these children. Methods : We reviewed case records of all children diagnosed as pediatric HIV infection since 1995 in our department at a tertiary care hospital in north India. Since September 1999, all children with HIV infection registered in our clinic were prospectively followed up. Complete clinical and laboratory evaluation was performed at baseline and thereafter children were followed up. The children were managed according to standard treatment guidelines. Results : 109 children (82 boys, 27 girls) were diagnosed to have HIV infection. The median (range) age at presentation was 48 months (range: 0.75 months -180 months). Eighty one (74.3%) children acquired the infection vertically. Ninety-one (83.5%) children were symptomatic at time of presentation. The common symptoms in the former were failure to thrive (81.3%), recurrent fever (73.6%), diarrhea (50.5%) and recurrent or persistent pneumonia (44%). All children had poor nutritional status at baseline. Of the 67 children who followed up, 36 were receiving antiretroviral drugs (32 received 3 drugs), while families of 31 children did not opt for antiretroviral therapy. Children receiving antiretroviral therapy showed improvement in nutritional parameters. Conclusion : Majority of children with HIV infection presented with various clinical manifestations, poor nutritional status and immunosuppression. Administration of nevirapine based antiretroviral therapy leads to improvement in growth and immune restoration. [Indian J Pediatr 2006; 73 (3) : 201-204]
HIV/AIDS - Research and Palliative Care, 2015
Anemia and growth retardation are common manifestations of HIV-positive children, which threaten their lives. Therefore, this study tried to assess the burden of anemia and the nutritional status of HIV-positive children receiving antiretroviral therapy (ART) in eastern Ethiopa. Patients and methods: A total of 108 records of children on ART followed up in Hiwot Fana Specialized University Hospital from 2007 to 2010 were retrospectively reviewed from November 1 to November 30, 2011. Results: Approximately 54.4% of the children had been anemic before the initiation of their ART (at baseline): 7.8% were severely anemic and 44.7% were moderately anemic. These percentages were higher in preschool children than in school children (adjusted odds ratio [AOR]: 4.80 [95% confidence interval {CI}: 1.96, 11.75]), and were higher in males than in females (AOR: 2.61 [95% CI: 1.06, 6.45]). The prevalence of anemia was reduced to 39.2% 1 year after initiation of ART. The increasing of hemoglobin values was highly significant for both zidovudine (AZT)-and stavudine (d4T)-based ART (P,0.05). At baseline, 51.6% of the study subjects were underweight (weight-forage Z score less than-2 standard deviation [SD]); 49.1% were stunted (height-forage Z score less than-2 SD); and 31.5% were wasted (body mass index less than-2 SD), which, after a year on ART, declined to 8.9%, 15.9%, and 9.8%, respectively. Conclusion: There was high prevalence of anemia and growth failure among HIV-infected children in the study area. However, there was a decline after initiation of ART. Therefore, adherence counseling to strengthen the uptake of ART is recommended. Moreover, large-scale, prospective studies should be done to understand the magnitude and etiology of the problems with HIV-negative control groups.
Nutritional and haematological status of human immunodeficiency virus infected children
International Journal of Contemporary Pediatrics, 2016
Children are innocent victim of HIV infection. Majority of children get infected through vertical transmission. 1 About 1200 children under 15 years of age are contracting HIV infection everyday world over. 2 Perinatally infected children become symptomatic usually by 5 years of age. Clinical course and presentation in children are different than adults. Most of the children present with failure to thrive and anaemia. 3-6 Severe malnutrition, chronic diarrhoea, anaemia, serious pyogenic infections, disseminated tuberculosis and oral candidiasis are associated with increased risk of being HIV positive. 7 Apart from other reasons, chronic diarrhoea is a major cause of malnutrition in HIV infected children. Isospora belli and cryptosporidium parvum are common causes of chronic diarrhoea in Indian studies. 8 E. histolytica, Giardia lamblia, E. coli ABSTRACT Background: Under nutrition and anaemia are among the commonest presenting signs in human immunodeficiency virus (HIV) infected children. Cause could be multi factorial. HIV infection itself may produce this situation. Opportunistic infections, nutritional deficiencies and bone marrow suppression due to various factors could be the other reasons. To study the nutritional and haematological status in HIV infected children this study was undertaken. Methods: 140 children of both sexes, between the age 18 months to 15 years, who were diagnosed HIV positive as per guide lines of national AIDS control organization of India, were included in this study. Their anthropometric, general and systemic examinations were done. Haematological investigations including complete blood count (CBC), general blood picture (GBP), CD4 count was done in all cases. They were classified in clinical and immunological staging according to WHO classification criteria. Bone marrow aspiration was performed in 43 children. They were investigated for suspected opportunistic infections as well. Results: Out of 140 chidren, 91 were male and 49 were female. 47 children were orphan and 111 children were in low socioeconomic status. 101 children were significantly under nourished. No child was nutritionally normal. Clinical signs of vitamin A and D deficiency was seen in 21 and seven children respectively. 85% children were anaemic and most common morphology was normocytic normochromic blood picture. Lymphopenia was seen in 43.57%, granulocytopenia in 48.57% and thrombocytopenia in 30.71% children. There was no significant finding in bone marrow examination. Conclusions: This study concludes that in children, commonest route of infection was vertical transmission. Mean age of presentation was 7.67 years. Varying degree of mal nutrition and anaemia was noted in more than 85% HIV infected children. No child was nutritionally normal.
The Journal of Infection in Developing Countries, 2014
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.
The present communication deals with the profile of HIV infected children belonging to pre-HAART (pre-Highly Active Anti Retroviral Therapy) era and HAART era to know the status of anemia and growth pattern who attended the ART centre, Govt. General Hospital, Vijayawada, Andhra Pradesh, India. A cross-sectional record based study was carried out in 125 HIV infected children in ART centre from 2009 to 2011. Hemoglobin, height, weight, BMI, waist and hip ratio were calculated according to the standard protocols. The CD4 count was estimated using BD FACS caliber flow cytometer and results were statistically analyzed. According to the present study 125 subjects of age group 1-20 years were chosen. The subjects in pre-HAART era (75 subjects) showed low level of Hb content 6.9 gm/dL in male and 6.3 gm/dL in female subjects; the mean BMI level was 20.43 in male and 18.47 in female subjects and showed a significant increase (p<0.05) in mean CD4 counts from 592 to 790 cells/cmm from baseline count to follow up count after 18 months. The study patients in HAART era (45 subjects) significant decrease (p<0.001) in Hb content from 7.3 to 6.5 gm/dL and significant increase (p<0.05) in BMI level from 18.1 to 22.6 and showed a significant increase (p<0.001) in CD4 counts from 174 to 902 cells/cmm from baseline to follow up treatments. Our study reinforces the finding that anemia, growth pattern of HIV infection in Indian children with prognostic significance.
Indian Journal of Child Health
Background: Children living with human immunodeficiency virus (CLHIV) are physically stunted and underweight compared to normal children. Objective: The aim of this study was to determine the physical growth (height, weight, and body mass index [BMI]) of children infected with HIV according to age, gender, sociodemographic factors, antiretroviral therapy (ART), and health status and to compare their physical growth with two other groups, i.e., exposed uninfected children and unexposed uninfected children and to determine the extent of growth retardation and the effect of ART on the reversal of growth retardation. Materials and Methods: A 3-year study on growth and development of CLHIV was conducted at Action, Service, Hope Foundation, a non-governmental institution working in the field of HIV/AIDS. Three groups of children were compared-63 CLHIV, 98 exposed uninfected children, and 70 unexposed uninfected children. Their nutritional status in terms of weight for age, height for age, BMI, sexual maturity, hemoglobin, and serum albumin were compared. Results: Among CLHIV, 28.1% of children were underweight with Z score of <−2, compared to 12.5% of exposed uninfected children, and 14.3% unexposed uninfected children. Height for age Z scores showed 29.8% were stunted with Z score <−2 among CLHIV, with 16.7% and 11.4% among the exposed uninfected and unexposed uninfected, respectively. Statistically significant difference was also observed in Tanner's sexual maturity with CLHIV showing slower sexual maturation. The incidence of anemia was highest among CLHIV and slightly higher in those on ART. Conclusions: This study shows that CLHIV are comparatively more stunted heightwise and have decreased weight for age, delayed sexual maturation, and more significant anemia when compared to exposed uninfected children and unexposed uninfected children. This physical growth retardation is not reversed completely by addition of ART.