Effect of Antiretroviral Therapy in Human Immunodeficiency Virus-infected Children
Pimpanada Chearskul MD*, Kulkanya Chokephaibulkit MD*, Sanay Chearskul MD*, Wanatpreeya Phongsamart MD*, Nottasorn Plipat MD, MS*, Keswadee Lapphra MD*, NirunVanprapar MD, MS*
Affiliation : *Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Background : The appropriate timing of antiretroviral (ARV) therapy initiation in children with human
immunodeficiency virus (HIV) infection has been uncertain. 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.
Materials and Methods : 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/mm3. 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%.
Keywords : HIV-infected children, Antiretroviral therapy, Survival, HAART
