By Ed Susman
SYDNEY, AUSTRALIA -- July 25, 2007 -- Children infected with HIV in resource-poor settings who begin treatment on antiretrovirals have an 86% survival rate after 2 years, but few of these children maintain viral loads that are undetectable, researchers said here at the 4th International AIDS Society (IAS) Conference on HIV Pathogenesis, Treatment and Prevention.
"Our treatment outcomes in children are a reflection of how difficult it has been to treat children with drugs that aren't designed for them," said Myrto Schaefer, MD, Pediatric HIV/AIDS Advisor, Médecins Sans Frontières, Sydney, Australia.
"Because appropriate [antiretroviral] formulations have not been available for children, we've had to treat them by cutting adult tablets in two, or give them syrups that are hard to measure and swallow. This approximate method of dosing and administration may be what is contributing to the less-than-ideal virological outcomes we are finding," she explained.
In the study, presented as a poster on July 24th, Dr. Scheafer described virological, pharmacological, and adherence outcomes evaluated at 12 and 24 months on treatment for a cohort of children in rural Uganda.
The probability of remaining alive and in care was good, with 91% and 86% of children on treatment at 6 months and 12 months, respectively. However, viral load, which are a strong predictor of long-term survival, were not as encouraging.
A viral load of below 400 copies was achieved in 59% of children after 12 months and 33% after 24 months. Of children identified with a high viral load (over 1000 copies), 85% showed resistance to one or more of the commonly used first-line antiretroviral drugs.
"We are concerned that we will not have treatment options for these children 5 or 10 years down the road," said Annette Sohn, MD, Assistant Professor of Pediatric Infectious Diseases, University of California, San Francisco, California, who is working on pediatric HIV research in Ho Chi Minh City, Vietnam.
Dr. Sohn said studies need to be undertaken with children in resource-limited settings so that problems with food distribution, childhood illnesses, and other issues unique to those areas can be addressed.
[Presentation title: Children Antiretroviral Treatment Outcomes After 12 or 24 Months of HAART in the HIV Care Program of North-Western Uganda. Abstract TUPEB132]
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