Paediatric human immunodeficiency virus treatment outcomes from a resource-limited setting in South Africa: Highly active antiretroviral therapy alone is not enough

Abstract

Comprehensive care of human immunodeficiency virus (HIV)-infected children in the resource-poor setting is challenging, and published reports on treatment outcomes in this setting are limited. The aim of this study was to evaluate outcomes of HIV-infected children initiated on highly active antiretroviral therapy (HAART) between April 2005 and April 2009 at a primary health-care centre in Alexandra Township, South Africa. Of the 337 patients initiated on HAART, 83% (281 of 337) were still in care at the time of analysis. The median age at initiation was five years six months [interquartile range (IQR) 2.4–8.8], with only 11% (37 of 337) less than 1 year of age. At one and two years of treatment follow-up, the mean increase in CD4% was 12.8% (8.7–17.4) and 17.9% (11.7–21.6), respectively, while 86% (172 of 199) and 88% (99 of 112) were virally suppressed. Improvement in body mass index (BMI), height-for-age (HAZ) and weight-for-age Z scores (WAZ), along with low rates of lost to follow-up (3.6%; 12 of 337) and death (2.3%; eight of 337) were encouraging. There was less recovery in HAZ in children older than 10 years. 65% (182 of 281) of children remained on their initiating regimens; however, 25% (72 of 281) required single drug substitutions for lipodystrophy. Evidence of some drug resistant strains needs addressing. There was a high tuberculosis (TB) coinfection rate, with 66% (225 of 337) having TB ever diagnosed. Thirty-two per cent (108 of 337) were orphans and many psychosocial problems were identified. We concluded that although the outcomes from this resource-limited paediatric HAART treatment programme are encouraging, awareness and appropriate management of the many co-existing challenges, by a multidisciplinary team, is very important for success. Sustained provision of HAART is essential; however, HAART alone is not enough.

Keywords:

• HIV treatment outcomes
• paediatrics
• psychosocial problems
• resource-limited settings

Acknowledgements

The authors thank Dr. Sharon Patz, Dr. Jayne Cunningham, Sr. Tsakani Nkasha, Sr. Happy Mathe, Lebogang Molubi, Wendy Mthembu and Thembi Phakhati, for their passion and commitment, Arnold Moholola, for his assistance with data capturing, and all the staff at the Alexandra Health Centre and University Clinic and Phatsima Khanya Clinic, for each playing a very valuable part in the care of the children.