Outcomes of HIV-infected orphaned and non-orphaned children on antiretroviral therapy in Western Kenya

Winstone M. Nyandiko, Samuel Ayaya, Esther Nabakwe, Constance Tenge, John E. Sidle, Constantin T. Yiannoutsos, Beverly Musick, Kara Wools-Kaloustian, William M. Tierney

Research output: Contribution to journalArticle

91 Scopus citations


OBJECTIVES: Determine outcome differences between orphaned and non-orphaned children receiving antiretroviral therapy (ART). DESIGN: Retrospective review of prospectively recorded electronic data. SETTING: Nine HIV clinics in western Kenya. POPULATION: 279 children on ART enrolled between August 2002 and February 2005. MAIN MEASURES: Orphan status, CD4%, sex- and age-adjusted height (HAZ) and weight (WAZ) z scores, ART adherence, mortality. RESULTS: Median follow-up was 34 months. Cohort included 51% males and 54% orphans. At ART initiation (baseline), 71% of children had CDC clinical stage B or C disease. Median CD4% was 9% and increased dramatically the first 30 weeks of therapy, then leveled off. Parents and guardians reported perfect adherence at every visit for 75% of children. Adherence and orphan status were not significantly associated with CD4% response. Adjusted for baseline age, follow-up was significantly shorter among orphaned children (median 33 vs. 41 weeks, P = 0.096). One-year mortality was 7.1% for orphaned and 6.6% for non-orphaned children (P = 0.836). HAZ and WAZ were significantly below norm in both groups. With ART, HAZ remained stable, while WAZ tended to increase toward the norm, especially among non-orphans. Orphans showed identical weight gains as non-orphans the first 70 weeks after start of ART but experienced reductions afterwards. CONCLUSIONS: Good ART adherence is possible in western rural Kenya. ART for HIV-infected children produced substantial and sustainable CD4% improvement. Orphan status was not associated with worse short-term outcomes but may be a factor for long-term therapy response. ART alone may not be sufficient to reverse significant developmental lags in the HIV-positive pediatric population.

Original languageEnglish (US)
Pages (from-to)418-425
Number of pages8
JournalJournal of Acquired Immune Deficiency Syndromes
Issue number4
StatePublished - Dec 2006


  • Antiretroviral therapy
  • Children
  • HIV
  • Orphan
  • Western Kenya

ASJC Scopus subject areas

  • Virology
  • Immunology

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