Favourable outcomes in children treated with HAART in the MSF programmes
Polly Clayden, HIV i-Base
As of March 2005, Medicins Sans Frontiers (MSF) had 36,000 patients on HAART worldwide, 2,300 of these are children <13 years old.
In a late breaker presentation Pierre Humblet from MSF presented data showing favourable outcomes from a cohort of 1,840 children <13 years old receiving HAART in 11 MSF programmes across Africa.
Of those receiving treatment 883 (48.4%) were girls and there were few very young infants – 96% were older than 18 months (median age 5.9 years IQR 3.6-8.3). The majority of the children (85%) had a CD4 percentage of <15% on initiation of therapy.
Ninety seven percent of the children received WHO recommended first line combinations, and 65% received cut up fixed dose combination Triomune (3TC/d4T/nevirapine) tablets.
Median follow up for the children was 6.9 months, with 54% having over 6 months and 29% over 12 months. The investigators reported a median CD4 percentage increase of + 9%, +11% and +13% at 6, 12 and 24 months respectively, and a median weight gain of + 2kg, + 3kg and +5kg at the same months of follow up.
The investigators reported that as of March 2005 1543 (84%) of children were alive and on treatment, 111 (6%) had died, 79 94%) were lost to follow up, 28 (1.5%) stopped treatment, 3 (0.2%) transferred and 76 (4%) had unknown. One hundred and three (5.6%) children reported side effects causing 79 (4.3%) to switch drugs. Only 4 children have so far required second line therapy. Survival at 6,12 and 24 months was 94%, 92% and 91% respectively.
The authors wrote: This data shows very satisfactory outcomes (comparable to those in developed countries) among children offered HAART under routine programme conditions in resource-limited settings. They continue: Our findings strongly favour the rapid integration of HAART for children within the scaling up process in these settings.
Dr Humlet acknowledged that the study has limitations. So far, there are no virological outcomes for the children, the systems of reporting are not standardised, and side effects are probably underreported. He added that only 6% of the patients in the MSF cohort currently receiving HAART are children. Furthermore, that obstacles are lack of paediatric fixed dose combinations and confidence of healthcare workers to treat children.
AIDS Working Group, Epicentre, Medicins Sans Frontieres. Very satisfactory outcomes can be achieved in children treated with highly active antiretroviral treatment under programme conditions in resource-limited settings: the experience of Medicins Sans Frontieres. 3rd IAS Conference on HIV Pathogenesis and Treatment, Rio de Janeiro, 2005. Abstract WeOaLB0201.