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Open Access Research article

Virologic, immunologic and clinical response of infants to antiretroviral therapy in Kampala, Uganda

Vincent J Tukei1*, Miriam Murungi1, Alice R Asiimwe1, Daniella Migisha1, Albert Maganda1, Sabrina Bakeera-Kitaka3, Israel Kalyesubula1, Philippa Musoke23 and Adeodata Kekitiinwa1

Author Affiliations

1 Baylor College of Medicine-Bristol Myers Squibb Children’s Clinical Center of Excellence at Mulago Hospital, Kampala, Uganda

2 Makerere University-Johns Hopkins University Research Collaboration Clinic, Kampala, Uganda

3 Department of Pediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda

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BMC Pediatrics 2013, 13:42  doi:10.1186/1471-2431-13-42

Published: 27 March 2013

Abstract

Background

Antiretroviral therapy (ART) is known to save lives. Among HIV-infected infants living in resource constrained settings, the short and long term benefits of ART are only partially known. This study was designed to determine the virologic, immunologic and clinical outcomes of antiretroviral therapy in a cohort of HIV-infected infants receiving care from an outpatient clinic in Kampala, Uganda.

Methods

A prospective cohort of HIV-infected infants receiving treatment at the Baylor-Uganda clinic was analyzed. Patients were diagnosed, enrolled and followed up at the clinic. HIV viral load, CD4 cell counts and clinical progress were assessed during follow-up. Descriptive statistical analysis and logistic regression modeling to determine predictors of treatment success were conducted.

Results

Of 91 HIV-infected infants enrolled into the cohort, 53 (58.2%) infants were female; 43 (47.3%) were 6 months of age or younger, and 50 (55.6%) had advanced HIV/AIDS disease (Clinical stage 3 or 4). Eighty four infants started ART and 78 (92.9%) completed 6 months of treatments. Fifty six (71.8%) infants attained virologic suppression by month-6 of ART, and at month-12 of ART, the cumulative probability of attaining viral suppression was 83.1%. None of the baseline infant factors (age, sex, WHO stage, CD4 cell percent, weight for age, or height for age z-score) predicted treatment success. There was an increase in CD4 cells from a baseline mean of 23% to 30% at month-6 of treatment (p<0.001) and by month-24 of ART, the mean CD4 percent was 36%. A total of 7 patients died while on ART and another 7 experienced adverse events that were related to treatment.

Conclusion

Our results show that, even among very young patients from resource constrained settings, ART dramatically suppresses HIV replication, allows immune recovery and clinical improvement, and is safe. However, baseline characteristics do not predict recovery in this age group.

Keywords:
Infant; HIV; Antiretroviral therapy; Mortality; Malnutrition