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 Sidle, Constantin Yiannoutsos, Beverly Musick, Kara Wools-Kaloustian, William M. Tierney

Research output: Contribution to journalArticle

88 Citations (Scopus)

Abstract

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
Pages (from-to)418-425
Number of pages8
JournalJournal of Acquired Immune Deficiency Syndromes
Volume43
Issue number4
DOIs
StatePublished - Dec 2006

Fingerprint

Kenya
HIV
Orphaned Children
Therapeutics
Mortality
Centers for Disease Control and Prevention (U.S.)
Weight Gain
Parents
Pediatrics
Weights and Measures

Keywords

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

ASJC Scopus subject areas

  • Virology
  • Immunology

Cite this

Outcomes of HIV-infected orphaned and non-orphaned children on antiretroviral therapy in Western Kenya. / Nyandiko, Winstone M.; Ayaya, Samuel; Nabakwe, Esther; Tenge, Constance; Sidle, John; Yiannoutsos, Constantin; Musick, Beverly; Wools-Kaloustian, Kara; Tierney, William M.

In: Journal of Acquired Immune Deficiency Syndromes, Vol. 43, No. 4, 12.2006, p. 418-425.

Research output: Contribution to journalArticle

Nyandiko, Winstone M. ; Ayaya, Samuel ; Nabakwe, Esther ; Tenge, Constance ; Sidle, John ; Yiannoutsos, Constantin ; Musick, Beverly ; Wools-Kaloustian, Kara ; Tierney, William M. / Outcomes of HIV-infected orphaned and non-orphaned children on antiretroviral therapy in Western Kenya. In: Journal of Acquired Immune Deficiency Syndromes. 2006 ; Vol. 43, No. 4. pp. 418-425.
@article{23d2273b85c24749aec48c4484585fc4,
title = "Outcomes of HIV-infected orphaned and non-orphaned children on antiretroviral therapy in Western Kenya",
abstract = "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.",
keywords = "Antiretroviral therapy, Children, HIV, Orphan, Western Kenya",
author = "Nyandiko, {Winstone M.} and Samuel Ayaya and Esther Nabakwe and Constance Tenge and John Sidle and Constantin Yiannoutsos and Beverly Musick and Kara Wools-Kaloustian and Tierney, {William M.}",
year = "2006",
month = "12",
doi = "10.1097/01.qai.0000243122.52282.89",
language = "English",
volume = "43",
pages = "418--425",
journal = "Journal of Acquired Immune Deficiency Syndromes",
issn = "1525-4135",
publisher = "Lippincott Williams and Wilkins",
number = "4",

}

TY - JOUR

T1 - Outcomes of HIV-infected orphaned and non-orphaned children on antiretroviral therapy in Western Kenya

AU - Nyandiko, Winstone M.

AU - Ayaya, Samuel

AU - Nabakwe, Esther

AU - Tenge, Constance

AU - Sidle, John

AU - Yiannoutsos, Constantin

AU - Musick, Beverly

AU - Wools-Kaloustian, Kara

AU - Tierney, William M.

PY - 2006/12

Y1 - 2006/12

N2 - 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.

AB - 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.

KW - Antiretroviral therapy

KW - Children

KW - HIV

KW - Orphan

KW - Western Kenya

UR - http://www.scopus.com/inward/record.url?scp=33750952719&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=33750952719&partnerID=8YFLogxK

U2 - 10.1097/01.qai.0000243122.52282.89

DO - 10.1097/01.qai.0000243122.52282.89

M3 - Article

VL - 43

SP - 418

EP - 425

JO - Journal of Acquired Immune Deficiency Syndromes

JF - Journal of Acquired Immune Deficiency Syndromes

SN - 1525-4135

IS - 4

ER -