Paediatric antiretroviral treatment programmes in sub-Saharan Africa: a review of published clinical studies

  • Mary-Ann Davies
  • Matthias Egger
  • Olivia Keiser
  • Andrew Boulle

Abstract

Knowledge of the experience and outcomes of current paediatric antiretroviral treatment (ART) programmes in sub-Saharan Africa can inform new programmes in the region as well as enhance existing ones. This is urgently needed to facilitate the scale-up of treatment, which is needed to address the burden of paediatric HIV cases on the continent. We reviewed the characteristics and outcomes of programmes with clinical paediatric ART studies published prior to 1 January 2008. The outcomes of the studies were comparable to similar ones from developed countries; however, the duration of follow-up was relatively limited in almost all the studies reviewed. One-year survival probability was between 84% and 91%, and considerable improvement in the clinical, immunologic and viral status of the paediatric patients was generally recorded. Loss to follow-up was less than 10% in all but two studies. Adherence to treatment was good and few adverse events were reported. This is despite the fact that many programmes were subject to enormous constraints in terms of health services, and despite widespread use of adult fixed-dose combinations for paediatric patients, including young infants. While the majority of children commencing ART were severely ill, most children were old (median age >5 years for almost all studies) with relatively few infants and young children (age <2 years) receiving treatment. This is in contrast to knowledge of rapid disease progression in the majority of HIV-infected  infants and despite the World Health Organization’s recent recommendations to commence ART in all HIV-infected infants less than one year old. There is an urgent need to address barriers to ART for infants. Studies of the outcomes of programmes treating infants as well as those with longer-term follow-up are also needed.

Keywords: children, growth monitoring, HIV/AIDS, infants, mortality, programme assessment, survival, treatment issues, treatment practices, WHO guidelines

African Journal of AIDS Research 2009, 8(3): 329–338

Author Biographies

Mary-Ann Davies
Infectious Diseases Epidemiology Unit, School of Public Health and Family Medicine, University of Cape Town, Anzio Road, Observatory 7925, Cape Town, South Africa
Matthias Egger
Institute of Social and Preventive Medicine, Finkenhubelweg 11, Bern CH-3012, Switzerland
Olivia Keiser
Institute of Social and Preventive Medicine, Finkenhubelweg 11, Bern CH-3012, Switzerland
Andrew Boulle
Infectious Diseases Epidemiology Unit, School of Public Health and Family Medicine, University of Cape Town, Anzio Road, Observatory 7925, Cape Town, South Africa
Section
Articles

Journal Identifiers


eISSN: 1608-5906
print ISSN: 1727-9445