HAART is effective in African children in a resource-limited setting

Researchers in Abidjan, Cote D’Ivoire, and in Paris, France, conclude from a study of the effects of HAART in an observational cohort of 159 HIV positive children in Cote d’Ivoire, that it is possible to treat African children in a resource-limited setting and that this treatment appears to be as effective as in developed countries.

Cote d’Ivoire is the West African country with the highest prevalence of HIV and 80,000 children under 15 years are infected with the virus, most undiagnosed. This was one of the first studies to analyse the feasibility and results of ARV multitherapy in African children.

The researchers followed 78 (49%) children receiving HAART for a mean duration of 21 months. Mean age of treatment initiation was 7.2 years (median 6.5; range 0.7-15.2). All were from families with limited resources and 29 were from very poor families (income less than 30 euros a month). The children were given trademark drugs with the exception of d4T (30mg) which was replaced for a few months by a generic made by Cipla in India. Due to a shortage of ddI and 3TC, treatment was totally interrupted in eight children for a total of 204 days (median and mean 25.5). Two NRTIs were given with either a PI or an NNRTI. Thirteen of the youngest children received the drugs as syrup, the rest received adult formulations, doses calculated according to weight.

Z-score, CD4 count and viral load were measured before starting HAART and every six months thereafter. Probability of survival and incidences of pneumonia and acute diarrhoea were calculated.

Mean weight-for-age Z scores before treatment were –2.02 and after 620 days were -1.39 (P<0.01). Mean height-for-age Z scores were –2.03 before and –1.83 after (P=0.51). Incidence of pneumonia was 0.07/child-month before and 0.025 after (P=0.002). Incidence of acute diarrhoea was 0.12/child-month before and 0.048 (P<0.001) (incidence changes statistically significant only in children <6.5 years).

Overall the probability of survival under HAART was 72.8% at 24 months for children with <5% CD4+ T cells versus 97.8% in children with >/=5% (P=0.01).

At start of treatment, median viral load was 5.41 log10 copies/mL and CD4 percentage was 7.7%. After an average of 756 days on treatment, 50% of patients had viral load below detection and 10% had 2.4-3.0 log10 copies/mL. The median CD4 percentage was 22.5%.

In their discussion, the authors write that under HAART, HIV RNA viral load was below the detection limit in about 50% of children, and 60% had <1000 copies/mL (3 log10 copies/mL). This is similar to what is generally observed in Europe and the United States.

They point out: “It will be a long time before antiretroviral treatment becomes generally available for children in Africa. Nevertheless, treatment for HIV should cover the whole family, including children. We hope that our study will help to eliminate the feeling of inevitability that surrounds this disease in children in Africa.”

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These results are clearly impressive. They demonstrate that children in the developing world can be successfully treated. This group deserves congratulations.