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15 May 2007

Volume 195, Number 10
The Journal of Infectious Diseases 2007;195:1411–1418
© 2007 by the Infectious Diseases Society of America. All rights reserved.
0022-1899/2007/19510-0005$15.00
DOI: 10.1086/514823
MAJOR ARTICLE

Antiretroviral Therapy for HIV‐1–Infected Children in Haiti

Erik George,1

Francine Noël,3

Gyrlande Bois,3

Rachelle Cassagnol,3

Louise Estavien,3

Patricia De Matteis Rouzier,3

Rose I. Verdier,3

Warren D. Johnson,1

Jean W. Pape,3

Daniel W. Fitzgerald,1 and

Peter F. Wright2

1Department of Medicine, Division of International Medicine and Infectious Diseases, Weill Medical College of Cornell University, New York, New York; 2Department of Pediatrics, Division of Pediatric Infectious Diseases, Vanderbilt University School of Medicine, Nashville, Tennessee; 3Groupe Haïtien d’Etude du Sarcome de Kaposi et des Infections Opportunistes, Port‐au‐Prince, Haiti

Background.Data are limited about the effectiveness of pediatric antiretroviral therapy (ART) in low‐income countries.

Methods.We report the outcomes of consecutively treating 236 human immunodeficiency virus type 1 (HIV‐1)–infected treatment‐naive children with triple ART in Port‐au‐Prince, Haiti, between 1 May 2003 and 30 April 2006.

Results.Kaplan‐Meier survival analysis at follow‐up demonstrated that 191 children (81%) remained in care, 21 (9%) were dead, and 24 (10%) were lost to follow‐up. Independent baseline predictors of mortality were age <18 months, CD4+ T cell percentage 5%, and weight‐for‐age Z score (WAZ) less than −3. Twelve months into ART, 56% of tested subjects had undetectable HIV‐1 RNA loads. Median CD4+ T cell percentages at 12 months increased by 15%, 11%, and 5% in children with baseline percentages of 5%, 6%–24%, and 25%, respectively ( ). The median WAZ at 12 months increased by 1.0, 0.6, and 0.2 in children with baseline WAZ less than −2, −2 to −1.1, and −1 or more, respectively ( ).

Conclusion.With continuous donor support, trained providers, and the availability of pediatric antiretroviral drug formulations, it proved feasible to deliver pediatric ART in Haiti. The effectiveness of this program should encourage efforts to make ART available for HIV‐infected children in poor countries.

Received 14 September 2006; accepted 16 November 2006; electronically published 3 April 2007.

Reprints or correspondence: Dr. Erik George, Dept. of Medicine, Div. of International Medicine and Infectious Diseases, Weill Medical College of Cornell University, 1300 York Ave., New York, NY 10021 ().

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Steven F. J. Callens, Nicole Shabani, Jean Lusiama, Patricia Lelo, Faustin Kitetele, Robert Colebunders, Ziya Gizlice, Andrew Edmonds, Annelies Van Rie, Frieda Behets. (2009) Mortality and Associated Factors After Initiation of Pediatric Antiretroviral Treatment in the Democratic Republic of the Congo. The Pediatric Infectious Disease Journal 28:1, 35-40
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K. E. Little, R. M. Bland, M. L. Newell. (2008) Vertically acquired paediatric HIV infection: the challenges of providing comprehensive packages of care in resource-limited settings. Tropical Medicine & International Health 13:9, 1098-1110
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Renaud Becquet, Lynne M Mofenson. (2008) Early antiretroviral therapy of HIV-infected infants in resource-limited countries: possible, feasible, effective and challenging. AIDS 22:11, 1365-1368
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Joanna Orne-Gliemann, Renaud Becquet, Didier K Ekouevi, Valériane Leroy, Freddy Perez, François Dabis. (2008) Children and HIV/AIDS: from research to policy and action in resource-limited settings. AIDS 22:7, 797-805
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Steven FJ Callens, Mehri S McKellar, Robert Colebunders. (2008) HIV care and treatment for children in resource-limited settings. Expert Review of Anti-infective Therapy 6:2, 181-190
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Elaine J Abrams. (2007) The unanswered question: when to initiate antiretroviral therapy in children with HIV infection. Current Opinion in HIV and AIDS 2:5, 416-425
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Siobhan Crowley, Adeodata Kekitiinwa, Paula Vaz. (2007) Clinical management of HIV infection in children. Current Opinion in HIV and AIDS 2:5, 410-415
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Lisa V. Adams and Paul Palumbo. (2007) The Time to Treat the Children Is Now. The Journal of Infectious Diseases 195:10, 1396-1398
Online publication date: 15-May-2007.
Citation-Full Text-PDF Version (149 kB)

  • Potential conflicts of interest: none reported.

    Financial support: Fondation Rodolphe Mérieux; Global Fund to Fight AIDS, Tuberculosis, and Malaria; President’s Emergency Plan for AIDS Relief; National Institute of Allergy and Infectious Diseases (grants AI64021, AI58257, and AI07613); Fogarty International Center (grants TW006896, TW006901, and TW00018); Elisabeth Glaser Pediatric AIDS Foundation.

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