Antiretroviral therapy in infected Haitian children Bois G., Wright P.F., Wilson G.,Noel F., Darius N.,Verdier R.I., Deshamps M.M., Fitzgerald.D, Johnson W.D., Pape J.W Les Centres GHESKIO, Port-au-Prince, Haiti and Weill Medical College of Cornell

1
Antiretroviral therapy in infected Haitian
children Bois G., Wright P.F., Wilson G.,Noel
F., Darius N.,Verdier R.I., Deshamps M.M.,
Fitzgerald.D, Johnson W.D., Pape J.WLes
Centres GHESKIO, Port-au-Prince, Haiti and Weill
Medical College of Cornell University, New York,
Ny, USASponsored by the United Nations
Childrens Fund (UNICEF ), and Global Funds
(GPATM)
2
Background

• Prevalence of HIV among pregnant women 2,9
  (2003)
• 400 HIV infected children have been followed at
  GHESKIO Centers over the last five years
• 25 of them would qualify for antiretroviral
  treatment, based on the CDC criteria

3
Survival of HIV-infected Infants
4
Objectives

• Reduce AIDS morbidity and mortality
• Improve quality of life
• Develop national guidelines for the care of
  HIV-infected Haitian Children

5
ART in Haitian ChildrenGHESKIO Population

• 124 HIV infected children are on ART
• 29 children treated with highly active ART since
  October 2002 (UNICEF )
• 95 children placed on ART since May 2003 ( Global
  Fund)

6
UNICEF Project (29 children )

• Age range 2- 15 years old
• 13 girls and 16 boys
• All presumed infected at birth
• 19 of the 29 are orphans only 1 child with both
  parents alive
• 14 of the 29 had received previous antiviral
  therapy, (mostly mono or bi therapy) which had
  been stopped due to economic reasons

7
Procedure
Comprehensive pediatric care
Immunization
Multidisciplinary Team Approach
Treatment and prevention of opportunistic
infection
Psychological Support
Nutritional Support
8
Schedule Events
At Initiation Every 1-4 weeks Every 24 weeks
History
Physical Examination
Compliance Assessment
WBC and CD4 count
Viral Load
Hepatic Function
Renal Function
9
ART Initiation criteria

• Based on CDC Criteria
• Clinical stages B and C
• Immunological Stages 2 and 3

10
ART Regimens

• AZT 3TC Nevirapine
• AZT 3TC Efavirenz
• Nevirapine was replaced by nelfinavir in one
  case due to severe rash

11
CLINICAL AND IMMUNOLOGICAL STAGESN 29 children
12
Baseline Characteristics
Age Clinical stage Median CD4 CD4 Viral Load
lt 5 years 7 6 AIDS, 1B 696 13 230,000
5-10 13 3 AIDS, 10B 376 10 20,000
gt 10 9 5 AIDS, 4B 229 11 40,000
13
12 month follow up
Age group Survival at 12 months Median Change in CD4 count Median Change in CD4
lt 5 years 7/7 alive 300 10
5-10 years 13/13 alive 220 10
gt 10 years 8/9 alive 90 7
14
Kaplan Meier Estimate of Survival at 12 months
among 29 children treated with ART
15
Conclusion

• Implementing antiretroviral therapy in Haitian
  HIV infected children demands an intensive
  multidisciplinary approach, but can clearly have
  an impact.
• HAART provides meaningful therapeutic benefits
  that can be documented by clinical and immune
  improvement of those children