HAART effective in reducing pediatric mortality, even in resource-limited settings

Edmonds A. PLoS Med. 2011;doi:10.1371/journal.pmed.1001044.

Initiating highly active antiretroviral therapy early markedly improved the survival of children infected with HIV, even in an area with limited resources, according to a study published online this week.

The observational cohort study, by Andrew Edmonds, PhD, University of North Carolina at Chapel Hill, and colleagues, looked at a cohort of 790 children with HIV living in Kinshasa, Democratic Republic of the Congo (DRC), between December 2004 and May 2010, which researchers said is a period during which the country was recovering from civil war. The researchers compared the HR of death had all children initiated HAART compared with those children who had not initiated HAART during follow-up. About 79% of the children had initiated HAART.

Using a marginal structural model, the researchers estimated that compared with no HAART, treatment with HAART reduced mortality during follow-up by 75%.

Most observational studies on the effects of antiretroviral treatment on child survival have been undertaken in high-income countries, such as Italy and the United States. But most children with HIV live in low-resource areas where multiple factors, such as delayed presentation to care and a higher incidence of comorbid conditions, may adversely affect treatment outcomes. Therefore, this study addresses a specific need for information on the effects of HAART on children with HIV living in low-income countries, the researchers said.

The researchers urged future research into how effective HAART is in children who are malnourished or those children with co-infections such as tuberculosis.

Disclosure: The researchers report no relevant financial disclosures.

The HIV care and treatment program at Kalembe Lembe Pediatric Hospital and Bomoi Healthcare Center, conducted in collaboration with the Kinshasa School of Public Health and the National AIDS Control Program, was funded by the CDC and Prevention Global AIDS Program and the President’s Emergency Plan for AIDS Relief. Additional support was provided from the Elizabeth Glaser Pediatric AIDS Foundation, the Belgian Development Cooperation, the William J. Clinton Foundation, the United Nations Children’s Fund, and the Global Fund to Fight AIDS, Tuberculosis and Malaria. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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