Management of severely symptomatic HIV infected children with highly active anti-retroviral treatment: a special emphasis on anthropometric profiles from Ethiopia.

Abstract

Background: Since the introduction of pediatric antiretroviral (ARV’s) drugs, as treatment of HIV/AIDS, in 2003 in Ethiopia, there has been hundreds of infected children treated with these drugs at Zewditu memorial hospital which was one of the two centres in the country, where Pediatric ARV’s has been introduced. As there is little information on the outcome of children taking HAART, we studied the outcome of ARV with more emphasis to the changes in the anthropometric profile.
Objective: The objective of the study was to assess the clinical profile and treatment outcome of severely symptomatic HIV infected Ethiopian children after they have been given highly active antiretroviral treatment.
Method: A longitudinal follow up study was undertaken in a tertiary hospital located in the centre of the capital city of Ethiopia. Two hundred fourteen eligible children aged below 15 years was enrolled over three year’s period and their treatment outcomes were recorded. The outcome of the treatment was measured in terms of weight gain, and changes in haemoglobin and CD4. Data were entered and analyzed using SPSS version 15.
Result: A significant and sustained increment was observed in the mean weight (p=0.001), height (p=0.001), hemoglobin (p=0.001), absolute CD4 count (p=0.002), CD4% (p=0.001). Stunting (p= 0.004), wasting (p=0.001) and underweight (p=0.002) showed significant reduction after ART intervention among the survivors. Few (7.5%) cases died over the three year period. Wasting (X²=45, p=0.001), stunting (X²=43, p=0.03), underweight (X²=11.2,p=0.02), anemia (X²=18.9,p=0.001), first 3 months after initiation of HAART (X²=29,p=0.001), was found to have significant association with death.
Conclusion: HAART brings a significant improvement in the anthropometric and immunologic status of HIV infected children among malnourished communities compared to regions with better nutritional status. Early detection and initiation of treatment of infants with HIV seems a program failure in our setting. The degree of mortality reduction may be improved further by Prevention and correction of the nutritional factors before and during ARV treatment.