ART impact in children with HIV may be comparable in resource-limited settings and in resource-rich settings

As many as 70% of children in resource-limited settings who are administered antiretroviral therapy for 12 months may achieve virologic suppression, according to findings published recently.

Researchers conducted a meta-analysis of findings for treatment-naive children in resource-limited settings who had been administered ART for 12 months. Eligible studies involved children aged 0 to 17 years.

The primary outcome measures included pooled estimates of the reported proportion of children with HIV RNA levels of <400 copies/ml and a change in percentage of CD4 cell counts. Children with missing 12-month data were assumed to have HIV RNA levels >400 and no change in CD4 cell counts.

Results after 12 months of ART indicated that the pooled proportion of children with HIV RNA virologic suppression was 70% (95% CI, 67%-73%).

On an individual patient level, the pooled estimate of change in percentage of CD4 counts was an absolute increase of 13.7% (95% CI, 11.8%-15.7%). Results from a fixed- and random-effects model yielded a change of 14.3% (95% CI, 11.3%-17.3%).

The pooled estimate of virologic suppression was 53% (95% CI, 50%-55%) in an approximated intention-to-treat analysis. This analysis indicated a change in CD4 count percentage of 8.5% (95% CI, 5.5%-11.4%).

Reporting reasons for missing data may need to be more consistent, according to the researchers. This consistency may aid in evaluating outcomes in the studied settings.

Ciranello AL et al. Clin Infect Dis. 2009;49:1915-1927.

This study reinforces our knowledge of the effectiveness of antiretroviral therapy in treating HIV-infected children in the developing world. The major challenge ahead is figuring out how to deliver this therapy to all the children and adults in the world who need it.

- Elizabeth Connick, MD

Director, University of Colorado Center for AIDS