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
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 Presidents 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 Childrens 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