AEGiS-15IAC: Response to antiretroviral therapy among treatment naïve children in Botswana.

15th International AIDS Conference

Bangkok, Thailand - July 11-16, 2004

Response to antiretroviral therapy among treatment naïve children in Botswana.

Int Conf AIDS 2004 Jul 11-16; 15:(abstract no. TuOrB1191)

Jibril HB, Bowman D, Kurup S, Motsamai OA, Schwarzwald H, Yarosh O, Anabwani GM, Evens DL, Musa-Aisien AS, Woldestadik EA, Kostova E
Botswana-Baylor Children's Clinical Center of Excellence/Princess Marina Hospital, Gaborone, Botswana

BACKGROUND: In 2001 the Botswana Government took a bold decision to provide its citizens with free antiretroviral treatment. Children who are HIV infected as determined by ELISA or PCR tests qualify for treatment. We report our experience on treatment-naïve children enrolled in the program between April 2002 and October 2003, in Princess Marina Hospital, Gaborone. They all received a three-drug combination comprising Zidovudine or Stavudine, Lamivudine and Nevirapine or Efavirenz. Only children who have completed at least 6 months of therapy are reported. Methodology: To evaluate the clinical, virological and immunological response to therapy in these children, their medical records were reviewed.

RESULTS: Of the 672 children currently on treatment, 232 qualify for analysis. 18 died (7.7% mortality); of the remaining 214:105 were males (49%); their mean age was 65 months. At initiation of therapy, mean values of parameters measured are: CD4 count 707cells/ml (15.2%) viral load, 404843 copies/ml; height: 97.8cm; weight: 14.8kg. 121 (56.5%) were in C3 category (CDC classification) indicating severe clinical state. At 3 months of treatment the mean CD4 increased to 25% while the VL fell to7330copies/ml (1.8 log drop). At 6 and 12 months, these values were 29% and 12035copies/ml (1.6 log drop); and 31% and 29254 (1.1 log drop). At 3, 6, and 12 months were 84%, 84% and 80% respectively achieved complete viral suppressionThe mean weight and height variations achieved at 6 and 12 months were 20%, 4%; and 28% and 8% respectively. Only two children were switched to the second line therapy giving a switch rate of 0.9% Conclusion An excellent response to ART was shown in these patients, with a durable virological suppression at 3 month which remained durable even at 12 month of therapy; appreciable increase in CD4 counts and growth. The very low switch rate confirms the durability of the first line regimen and its appropriateness for use in resource poor setting.

Keywords: AEGIS, CD4 Lymphocyte Count, Stavudine, Viral Load, Zidovudine, Anti-HIV Agents, Nevirapine, Lamivudine, HIV Infections, Antiretroviral Therapy, Highly Active, HIV Protease Inhibitors, HIV, Drug Therapy, Combination, Botswana, Child, Humans, Male, therapy, drug therapy

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TuOrB1191