Highly active antiretroviral therapies among HIV-1 infected children in Abidjan, Cote d'Ivoire

Objective: To describe the effect of highly active antiretroviral therapy (HAART) in HIV-1-infected African children. Study design: Observational ANRS 1244 cohort of 159 children with HIV between October 2000 and September 2002; 78 children (49%) receiving HAART were followed for a mean duration of 21 months. Methods: Weight-for-age Z-scores (WAZ), height-for-age Z-scores (HAZ), CD4 lymphocyte count and HIV-1 RNA viral load were measured before initiating HAART and every 6 months during treatment. Probability of survival and incidences of pneumonia and acute diarrhoea were calculated. Results: Values before and after 620 days of HAART, respectively, were -2.02 and -1.39 for mean WAZ, (P < 0.01); -2.03 and -1.83 for mean HAZ (P = 0.51); 0.07 and 0.025/child-month (P = 0.002) for incidence of pneumonia; and 0.12 and 0.048/ child-month for incidence of acute diarrhoea (P < 0.001) (incidence changes statistically significant only in children < 6.5 years). Overall, the probability of survival under HAART was 72.8% at 24 months for children with < 5% CD4 cells versus 97.8% in children with greater than or equal to 5% (P < 0.01). At HAART initiation, median viral load and CD4 cell percentage were 5.41 log(10) copies/ml and 7.7%, respectively. After 756 days of HAART, on average, 50% of patients had undetectable viral load and 10% had 2.4-3.0 log(10) copies/ml. The median CD4 percentage was 22.5%. Conclusion: In resource-limited setting, it is possible to use HAART to treat African children. This treatment appears as effective as in developed countries. (C) 2004 Lippincott Williams Wilkins.