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HIV/AIDS Children HAART immunologic and clinical outcome Jimma
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Immunologic and clinical outcomes of children on HAART: A retrospective cohort analysis at Jimma University Specialized Hospital
Abstract
BACKGROUND: The nature of human immunodeficiency virus infection in children has changed from an often fatal to a treatable chronic condition with highly active antiretroviral therapy. The outcome of the therapy depends on multiple factors such as non-adherence to treatment, selection of resistant viral strains, drug toxicity and socioeconomic factors. The objective of this study was to determine the immunologic and clinical outcomes of children who are on highly active antiretroviral therapy at the ART clinic, Jimma University Specialized Hospital.
METHOD: A three -year’s retrospective cohort analysis was conducted in July 2008 among children younger than 14 years of age getting highly active antiretroviral therapy in Jimma University Specialized Hospital. Data was collected using a pre-tested record review format and analyzed using SPSS for Windows version 16.0 and World Health Organization Anthro v2.0.2 software.
RESULT: Fifty three (55.2%) of the 96 patients were female, the mean age at initiation of treatment was 6 ± 4.2 years and the mean follow-up period was 13.7 ± 8 months. By the time of the study, 69 (71.9 %) patients were still on follow-up, 7 (7.3%) had died, 13 (13.5%) were lost to follow–up and the remaining 7(7.3%) were transferred-out. Majority (93.8%) of them were at WHO stage 3&4 during initiation of treatment. Median Weight-for-age Z-score improved from 0.09 to 0.26 after 6 month of treatment. Immunologic treatment failure was seen in 11(11.5%) of the patients; 5 of them also manifested clinical treatment failure. Severe drug toxicity occurred in 5 (5.2%) cases. Presence of chronic gastroenteritis, WHO clinical stage 4 at initiation and appearance of new opportunistic
infection after starting treatment were associated with immunologic treatment failure (p <0.03).
CONCLUSION: Majority of the patients were having advanced clinical stage at initiation of treatment. Mortality rate and anthropometric changes of HIV infected children on highly active antiretroviral therapy were similar but immunologic treatment failure, loss to follow-up and severe drug toxicity were higher in this study compared to other reports from developing countries. Therefor, early diagnosis and treatment of HIV/AIDS and treatment monitoring should be strengthened.
METHOD: A three -year’s retrospective cohort analysis was conducted in July 2008 among children younger than 14 years of age getting highly active antiretroviral therapy in Jimma University Specialized Hospital. Data was collected using a pre-tested record review format and analyzed using SPSS for Windows version 16.0 and World Health Organization Anthro v2.0.2 software.
RESULT: Fifty three (55.2%) of the 96 patients were female, the mean age at initiation of treatment was 6 ± 4.2 years and the mean follow-up period was 13.7 ± 8 months. By the time of the study, 69 (71.9 %) patients were still on follow-up, 7 (7.3%) had died, 13 (13.5%) were lost to follow–up and the remaining 7(7.3%) were transferred-out. Majority (93.8%) of them were at WHO stage 3&4 during initiation of treatment. Median Weight-for-age Z-score improved from 0.09 to 0.26 after 6 month of treatment. Immunologic treatment failure was seen in 11(11.5%) of the patients; 5 of them also manifested clinical treatment failure. Severe drug toxicity occurred in 5 (5.2%) cases. Presence of chronic gastroenteritis, WHO clinical stage 4 at initiation and appearance of new opportunistic
infection after starting treatment were associated with immunologic treatment failure (p <0.03).
CONCLUSION: Majority of the patients were having advanced clinical stage at initiation of treatment. Mortality rate and anthropometric changes of HIV infected children on highly active antiretroviral therapy were similar but immunologic treatment failure, loss to follow-up and severe drug toxicity were higher in this study compared to other reports from developing countries. Therefor, early diagnosis and treatment of HIV/AIDS and treatment monitoring should be strengthened.
