Clinical manifestations and treatment outcomes in HIV-1-infected children receiving antiretroviral therapy in Karachi, Pakistan

  • Fatima Mir The Aga Khan University, Karachi, Pakistan
  • Farah Naz Qamar The Aga Khan University, Karachi, Pakistan
  • Naila Baig-Ansari Indus Hospital Research Center, The Indus Hospital, Karachi, Pakistan
  • Azra Ghayas Abro Enhanced HIV/ AIDS Control Programme, Civil Hospital, Karachi, Pakistan
  • Syed Qamar Abbas Enhanced HIV/AIDS Control Program, Sindh, Pakistan
  • Mohammed Ahmed Kazi Enhanced HIV/AIDS Control Program, Sindh, Pakistan
  • Arjumand Rizvi The Aga Khan University, Karachi, Pakistan
  • Anita Kaniz Mehdi Zaidi The Aga Khan University, Karachi, Pakistan
Keywords: pediatric HIV, response, ARV, clinical manifestations, laboratory profile

Abstract

Introduction: The impact of antiretroviral (ARV) therapy on immunological and growth parameters in HIV-positive children in Pakistan has not been reported to date.

Methodology: A retrospective chart review of children diagnosed with HIV at the Sindh AIDS Control Proigramme (SACP) and registered at the Aga Khan University, Karachi, between January 2005 and 2013 was conducted, evaluating clinical and laboratory profiles of HIV+ ARV+ children for ARV impact (serial height and weight CD4 and viral counts).

Results: Twenty-four children were diagnosed and registered as HIV positive over five years, and 20 were started on ARV. Six were excluded from analysis (ARV duration < 6 months). Nine (64.3%) of 14 fulfilled WHO criteria for treatment failure at a median duration of 25 weeks (IQR 18-32) on ARV and underwent resistance genotyping. All nine had NNRTI resistance, two had high-grade NRTI resistance (≥ 4 thymidine analog mutations).

Median age at start of ARV was 71.5 weeks (IQR 37.5-119). Median baseline weight for age (WAZ) and height for age (HAZ) z-scores changed from -1.94 to 1.69 and -1.99 to -1.59, respectively, after six months of therapy. Median CD4 percentage and viral load at baseline changed from 13.8 to 17.8, while viral load changed from 285 × 104 copies to zero at six months.

Conclusions: ARV improved absolute CD4 and viral counts. Weight and height did not  improve significantly, highlighting the need for aggressive nutritional rehabilitation. Early development of ARV resistance in these children requires formal assessment.

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Author Biographies

Fatima Mir, The Aga Khan University, Karachi, Pakistan

Assistant Professor,

Department of Pediatrics & Child Health

Farah Naz Qamar, The Aga Khan University, Karachi, Pakistan

Assistant Professor,

Department of pediatrics and child Health

Naila Baig-Ansari, Indus Hospital Research Center, The Indus Hospital, Karachi, Pakistan
Epidemiologist/Research Faculty,
Azra Ghayas Abro, Enhanced HIV/ AIDS Control Programme, Civil Hospital, Karachi, Pakistan
In charge for the Treatment Centre
Syed Qamar Abbas, Enhanced HIV/AIDS Control Program, Sindh, Pakistan
ex-Deputy Manager
Mohammed Ahmed Kazi, Enhanced HIV/AIDS Control Program, Sindh, Pakistan
Provincial Manager
Arjumand Rizvi, The Aga Khan University, Karachi, Pakistan
Statistician
Anita Kaniz Mehdi Zaidi, The Aga Khan University, Karachi, Pakistan
Professore and Chair, Department of Pediatrics and Child Health
Published
2014-04-15
How to Cite
1.
Mir F, Qamar FN, Baig-AnsariN, Abro AG, Abbas SQ, Kazi MA, Rizvi A, Zaidi AKM (2014) Clinical manifestations and treatment outcomes in HIV-1-infected children receiving antiretroviral therapy in Karachi, Pakistan. J Infect Dev Ctries 8:519-525. doi: 10.3855/jidc.3782
Section
Original Articles