AIDS guidelines for children may not improve death rates but may improve treatment access

November 19, 2013, Public Library of Science

Recent changes to World Health Organization guidelines for starting anti-AIDS drugs (antiretroviral therapy—ART) in young children are unlikely to improve death rates but may increase the numbers of children receiving ART by simplifying access to treatment, according to a study by international researchers published in this week's PLOS Medicine.

The findings from a study, led by Michael Schomaker from the University of Cape Town in South Africa, suggest that, among southern African children aged 2-5 years at HIV diagnosis, there was no difference in three year between children in whom ART was started immediately and those in whom starting ART was deferred until their CD4 count and percentage (markers of progression of HIV infection) fell below 750 cells/mm3 and 25% respectively.

The authors reached these conclusions by using information from almost 3000 2-5 year old children with HIV who enrolled for ARV treatment in HIV clinics in South Africa, Malawi, and Zimbabwe to develop a model. From this model, the authors found that if all children had started ART immediately after diagnosis irrespective of CD4 value (2013 WHO guidelines) the estimated combined death rate would be 2.1% but if ART was started at a CD4 count below 750 cells/mm3 or a CD4% below 25% (2010 WHO guidelines) the figure was 2.2%, a statistically non-significant difference. However, the authors found higher death rates when ART was started at lower CD4 counts and the study is limited by lack of clinical information on the children and loss of follow up.

The authors conclude: "Our results indicate that in children aged 2-5 y in southern Africa, there is no difference in mortality between starting ART immediately and deferring until CD4% drops below 25% or CD4 count drops below 750 cells/mm3."

Explore further: Older children with HIV may need to start treatment sooner to normalize future CD4 count

More information: Schomaker M, Egger M, Ndirangu J, Phiri S, Moultrie H, et al. (2013) When to Start Antiretroviral Therapy in Children Aged 2-5 Years: A Collaborative Causal Modelling Analysis of Cohort Studies from Southern Africa. PLoS Med 10(11): e1001555. DOI: 10.1371/journal.pmed.1001555

Related Stories

Older children with HIV may need to start treatment sooner to normalize future CD4 count

October 29, 2013
Although younger children with HIV are at high risk of disease progression if not treated, new research published this week in PLOS Medicine indicates that they have good potential for achieving high CD4 counts (a measure ...

HIV elimination in South Africa could be achieved by current treatment policy

October 22, 2013
The current antiretroviral treatment policy in South Africa could lead to elimination of HIV within the country over the next 24 to 34 years, but a universal test and treat (UTT) approach could achieve elimination 10 years ...

No increase in risk of death for patients with well-controlled HIV, reports AIDS journal

March 11, 2013
For HIV-infected patients whose disease is well-controlled by modern treatment, the risk of death is not significantly higher than in the general population, according to a study published in AIDS, official journal of the ...

Early temporary ART for HIV-infected infants prevents damage to immune system and delays need for life-long treatment

August 21, 2013
Giving antiretroviral therapy (ART) immediately after diagnosis for a limited period of time is more beneficial than postponing treatment in young infants infected with HIV, slowing progression of the disease and delaying ...

Treatment leads to near-normal life expectancy for people with HIV in South Africa

April 9, 2013
In South Africa, people with HIV who start treatment with anti-AIDS drugs (antiretroviral therapy) have life expectancies around 80% of that of the general population provided that they start treatment before their CD4 count ...

CD4 count is non-inferior to viral load for treatment switching in adults with HIV

August 6, 2013
For adults infected with HIV in Thailand a monitoring strategy based on CD4 count (a type of white blood cell) is non-inferior to the recommended monitoring strategy measuring the amount of HIV virus in a patient's blood, ...

Recommended for you

HIV-1 genetic diversity is higher in vaginal tract than in blood during early infection

January 18, 2018
A first-of-its-kind study has found that the genetic diversity of human immunodeficiency virus type 1 (HIV-1) is higher in the vaginal tract than in the blood stream during early infection. This finding, published in PLOS ...

War in Ukraine has escalated HIV spread in the country: study

January 15, 2018
Conflict in Ukraine has increased the risk of HIV outbreaks throughout the country as displaced HIV-infected people move from war-affected regions to areas with higher risk of transmission, according to analysis by scientists.

Researchers offer new model for uncovering true HIV mortality rates in Zambia

January 12, 2018
A new study that seeks to better ascertain HIV mortality rates in Zambia could provide a model for improved national and regional surveillance approaches, and ultimately, more effective HIV treatment strategies.

New drug capsule may allow weekly HIV treatment

January 9, 2018
Researchers at MIT and Brigham and Women's Hospital have developed a capsule that can deliver a week's worth of HIV drugs in a single dose. This advance could make it much easier for patients to adhere to the strict schedule ...

New long-acting, less-toxic HIV drug suppresses virus in humanized mice

January 8, 2018
A team of Yale researchers tested a new chemical compound that suppresses HIV, protects immune cells, and remains effective for weeks with a single dose. In animal experiments, the compound proved to be a promising new candidate ...

Usage remains low for pill that can prevent HIV infection

January 8, 2018
From gritty neighborhoods in New York and Los Angeles to clinics in Kenya and Brazil, health workers are trying to popularize a pill that has proven highly effective in preventing HIV but which—in their view—remains woefully ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.