Pediatric care with regard to HIV-infected children living in sub-Saharan Africa has always been a challenge. A lack of infrastructure is primarily to blame, and many children live with the disease, despite the fact that studies show that antiretroviral treatment (ART) significantly decreases mortality rates in afflicted children.
The Baylor International Pediatrics AIDS Initiatives in Malawi, Lesotho, and Swaziland are particularly confronted with this challenge. Though evidence from both developed and developing countries regarding the effectiveness of antiretroviral treatment and its reduction of mortality in HIV-infected children does exist, numerous health system, financial, and human resource troubles prevent sub-Saharan initiatives from delivering quality pediatric HIV care. Despite such obstacles in these areas, mortality and clinical outcomes approaching those from developed countries are determined to be feasible in a new study published in the August issue of Pediatrics.
Researchers set out to determine mortality and immune status improvement in pediatric patients infected with HIV taking antiretroviral treatments in Malawi, Lesotho, and Swaziland. They conducted a retrospective study of patients 12-years of age and under taking antiretroviral treatments (ART) at three sites between 2004 and 2009. The study followed 2,306 patients with an average follow-up of 2.3 years. Unfortunately, immune system improvement at 12 months was less likely in patients with advanced conditions.
Despite the challenges that go along with pediatric ART in developing countries, the study found that low mortality and positive treatment outcomes are possible. The study also showed that outcomes are worse in younger patients and patients in which the disease is more advanced at the time of ART implementation. This highlights the importance of early intervention and treatment.
“Despite the challenges associated with the public health approach to implementation of comprehensive pediatric HIV care in developing countries,” note researchers, “additional resources need to be directed toward children who are still underrepresented in many national ART.”