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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Outcomes of HIV-infected orphaned and non-orphaned children on antiretroviral therapy in Western Kenya
Journal of Acquired Immune Deficiency Syndromes, Volume 43, No. 4, Year 2006
Notification
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Description
OBJECTIVES: Determine outcome differences between orphaned and non-orphaned children receiving antiretroviral therapy (ART). DESIGN: Retrospective review of prospectively recorded electronic data. SETTING: Nine HIV clinics in western Kenya. POPULATION: 279 children on ART enrolled between August 2002 and February 2005. MAIN MEASURES: Orphan status, CD4%, sex- and age-adjusted height (HAZ) and weight (WAZ) z scores, ART adherence, mortality. RESULTS: Median follow-up was 34 months. Cohort included 51% males and 54% orphans. At ART initiation (baseline), 71% of children had CDC clinical stage B or C disease. Median CD4% was 9% and increased dramatically the first 30 weeks of therapy, then leveled off. Parents and guardians reported perfect adherence at every visit for 75% of children. Adherence and orphan status were not significantly associated with CD4% response. Adjusted for baseline age, follow-up was significantly shorter among orphaned children (median 33 vs. 41 weeks, P = 0.096). One-year mortality was 7.1% for orphaned and 6.6% for non-orphaned children (P = 0.836). HAZ and WAZ were significantly below norm in both groups. With ART, HAZ remained stable, while WAZ tended to increase toward the norm, especially among non-orphans. Orphans showed identical weight gains as non-orphans the first 70 weeks after start of ART but experienced reductions afterwards. CONCLUSIONS: Good ART adherence is possible in western rural Kenya. ART for HIV-infected children produced substantial and sustainable CD4% improvement. Orphan status was not associated with worse short-term outcomes but may be a factor for long-term therapy response. ART alone may not be sufficient to reverse significant developmental lags in the HIV-positive pediatric population. © 2006 Lippincott Williams & Wilkins, Inc.
Authors & Co-Authors
Nyandiko, Winstone Mokaya
Kenya, Eldoret
Moi University
Ayaya, Samuel Omulando
Kenya, Eldoret
Moi University
Nabakwe, Esther Clyde
Kenya, Eldoret
Moi University
Tenge, Constance Nalianya
Kenya, Eldoret
Moi University
Sidle, John E.
United States, Indianapolis
Indiana University School of Medicine
Yiannoutsos, Constantin Theodore
United States, Indianapolis
Indiana University School of Medicine
United States, Indianapolis
Regenstrief Institute Inc
Musick, Beverly Sue
United States, Indianapolis
Indiana University School of Medicine
Wools-Kaloustian, Kara K.
United States, Indianapolis
Indiana University School of Medicine
Tierney, William M.
United States, Indianapolis
Indiana University School of Medicine
United States, Indianapolis
Regenstrief Institute Inc
Statistics
Citations: 113
Authors: 9
Affiliations: 3
Identifiers
Doi:
10.1097/01.qai.0000243122.52282.89
ISSN:
15254135
Research Areas
Infectious Diseases
Maternal And Child Health
Study Design
Cross Sectional Study
Cohort Study
Study Locations
Kenya