TITLE

Initial Response to Protease-Inhibitor-Based Antiretroviral Therapy among Children Less than 2 Years of Age in South Africa: Effect of Cotreatment for Tuberculosis

AUTHOR(S)
Reitz, Cordula; Coovadia, Ashraf; Ko, Stephen; Meyers, Tammy; Strehlau, Renate; Sherman, Gayle; Kuhn, Louise; Abrams, Elaine J.
PUB. DATE
April 2010
SOURCE
Journal of Infectious Diseases;4/15/2010, Vol. 201 Issue 8, p1121
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Background. South African guidelines recommend protease-inhibitor-based antiretroviral therapy (ART) with lopinavir-ritonavir for human immunodeficiency virus (HIV)-infected children <36 months of age.We investigated factors associated with viral suppression and mortality among young children initiating ART. Methods. Treatment-naive, ART-eligible, HIV-infected children (aged 6-104 weeks) were enrolled in an ART strategies trial in South Africa and initiated protease-inhibitor-based ART. Mortality and the probability of viral suppression (defined as HIV RNA load of <400 copies/mL) by 39 weeks after ART initiation were investigated. Results. Of 254 children who initiated ART, 99 (39%) were cotreated for tuberculosis during follow-up. The mortality rate was 14%. Factors predicting mortality were lower pre-ART weight-for-age z score and higher HIV RNA load. By 39 weeks, 84% of surviving children achieved viral suppression. Children who were not cotreated for tuberculosis were more likely to achieve viral suppression (94.8%) than were children who were receiving cotreatment at ART initiation (74.2%) or who started tuberculosis cotreatment after ART initiation (51.6%; P < ). Other .001 factors predicting lower probability of viral suppression were lower pre-ART weight- and length-forage z score, higher HIV RNA load, and World Health Organization disease stage. Conclusion. High rates of viral suppression can be achieved among infants and young children who initiate protease-inhibitor-based ART. Cotreatment for tuberculosis reduced viral suppression. How best to treat HIVinfected children who require tuberculosis treatment warrants urgent investigation.
ACCESSION #
48984910

 

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