Abstract
BackgroundHIV testing and treatment guidelines for children in sub-Saharan Africa have evolved over time, such that children are now treated at younger ages. The objective of this study was to describe the treatment experience for immunologic, virologic, and growth outcomes among HIV-infected Zambian children younger than 5 years of age from 2008 to 2018.MethodsParticipants enrolled in a clinical cohort study in Macha, Zambia and initiating antiretroviral treatment before 5 years of age between 2008 and 2015 were included in the analysis and followed up to the end of 2018. Outcomes, including growth, CD4+ T-cell percentage, viral suppression, and mortality, were evaluated among all children using longitudinal and survival analyses. Comparisons by age at treatment initiation (< 1, 1 to < 2, and 2 to < 5 years) were also evaluated.ResultsThree hundred eighty-one children initiating treatment before 5 years of age between 2008 and 2015 were included in the analysis. Growth metrics and CD4+ T-cell percentage improved over time after treatment initiation. However, 20% of children remained underweight and 40% of children remained stunted after the first 36 months of treatment. 85% of children had a viral load < 400 copies/mL after 12 months of treatment. However, children < 1 year at treatment initiation were more likely to have a detectable viral load in the first 12 months of treatment and less likely to achieve viral suppression compared to older children. Mortality was highest in the first 12 months of treatment, among underweight children, and among children initiating treatment in 2008–2010 compared to 2011–2015.ConclusionsMost children initiating antiretroviral treatment from 2008 to 2015 in rural Zambia responded well to treatment. However, many children remained underweight and stunted, and experienced high mortality rates during the first few months of treatment. This supports continued efforts to improve early infant diagnosis, nutritional support, and pediatric drug formulations.
Highlights
Human immunodeficiency virus (HIV) testing and treatment guidelines for children in sub-Saharan Africa have evolved over time, such that children are treated at younger ages
During the period for this analysis, HIV viral load testing was performed at the Center for Infectious Disease Research Zambia (CIDRZ) lab in Lusaka, Zambia
Characteristics of study population A total of 391 children younger than 5 years of age started antiretroviral therapy (ART) between January 1, 2008 and December 31, 2015, of whom 381 were included in the analysis (10 children were excluded who enrolled in the study after being on ART for more than 3 years)
Summary
HIV testing and treatment guidelines for children in sub-Saharan Africa have evolved over time, such that children are treated at younger ages. With increasing recognition of the benefits of early treatment in preventing HIV-related morbidity and mortality, especially among children in the first months and years of life [3, 4], guidelines evolved to recommend initiating treatment as soon as possible after diagnosis [5]. These changing requirements have increasingly broadened the number of children eligible for treatment. First-line treatment regimens have evolved as new and more effective drugs have been developed and rolled out, including dosing formulations for infants [2, 5]
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