Long-term outcomes of HIV-infected children in Thailand: the Thailand Pediatric HIV Observational Database
Phongsamart, W.; Hansudewechakul, R.; Bunupuradah, T.; Klinbuayaem, V.; Teeraananchai, S.; Prasithsirikul, W.; Kerr, S.J.; Akarathum, N.; Denjunta, S.; Ananworanich, J.; Chokephaibulkit, K.
International Journal of Infectious Diseases Ijid Official Publication of the International Society for Infectious Diseases 22: 19-24
2014
ISSN/ISBN: 1878-3511 PMID: 24576843 DOI: 10.1016/j.ijid.2013.12.011Document Number: 625200
To describe the outcomes of antiretroviral therapy (ART) in a large cohort of HIV-infected children in Thailand. The data were obtained from four collaborative referral sites around the country. Data from 2008 to March 2011 were collected prospectively, and data before 2008 were collected retrospectively. Of the 1139 children, 599 (52.6%) were female, and the duration of ART was a median 2.9 years (interquartile range (IQR) 3.3-5.5 years). At ART initiation, the median age was 7.1 years (IQR 3.4-10.0 years), CD4 percentage was 9.0% (IQR 3.0-17.0%), and 61.3% were in World Health Organization (WHO) stage 3 or 4. Seventy-four percent were initiated on an NNRTI-based regimen. The death and lost to follow-up rates were 1.3 (95% confidence interval (CI) 1.1-1.6) and 2.2 (95% CI 1.6-2.6)/100 patient-years of follow-up, respectively. At the last clinic visit of 919 children, the median CD4 percentage was 27.0% (IQR 23.0-32.0%) and 80.2% had HIV-RNA <40 copies/ml. WHO stage 1 or 2 at ART initiation was associated with having a viral load <40 copies/ml (p < 0.002), and baseline CD4 ≥15% and starting with a three-drug regimen were associated with achieving CD4 ≥25% (p<0.001). Although most children initiated ART at low CD4 levels, the majority achieved immune reconstitution and long-term virological control. Earlier treatment may improve these outcomes.
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