HIV-infected children in the Asia-Pacific region with baseline severe anemia: antiretroviral therapy and outcomes
Article Category: Brief communication (Original)
Published Online: Jan 31, 2017
Page range: 229 - 234
DOI: https://doi.org/10.5372/1905-7415.1003.484
Keywords
© 2016 Pagakrong Lumbiganon, Pope Kosalaraksa, Torsak Bunupuradah, David Boettiger, Vonthanak Saphonn, Khanh H. Truong, Nia Kurniati, Rawiwan Hansudewechakul, Viet C. Do, Tavitiya Sudjaritruk, Nagalingeswaran Kumarasamy, Nantakar Kongstan, Nik K. N. Yusoff, Lam V. Nguyen, Dewi K. Wati, Kamarul Razali, Annette H. Sohn, Azar Kariminia
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.
Background
Severe anemia is common among children infected with human immunodeficiency virus (HIV). The choice of antiretroviral (ART) regimen needs careful consideration. No information is available regarding the initial ART regimens used in the Asia-Pacific region and the rate of switch of ART regimens in HIV-infected children with severe anemia.
Objectives
To study the initial ART regimens and the rate of switch of ART regimens used during the first 36 months in HIV-infected children with severe anemia and to evaluate their clinical and laboratory outcomes.
Methods
We analyzed regional cohort data of 130 Asian children aged <18 years with baseline severe anemia (hemoglobin <7.5 g/dl) who started antiretroviral therapy (ART) between January 2003 and September 2013.
Results
At ART initiation, median age was 3.5 years old (interquartile range (IQR) 1.7 to 6.3) and median hemoglobin was 6.7 g/dL (IQR 5.9-7.1, range 3.0-7.4). Initial ART regimens included stavudine (85.4%), zidovudine (13.8%), and abacavir (0.8%). In 81 children with available hemoglobin data after 6 months of ART, 90% recovered from severe anemia with a median hemoglobin of 10.7 g/dL (IQR 9.6-11.7, range 4.4-13.5). Those starting AZT-based ART had a mortality rate of 10.8 (95% confidence interval (CI) 4.8-23.9) per 100 patient-years compared to 2.7 (95% CI 1.6-4.6) per 100 patient-years among those who started d4T-based ART.
Conclusion
With the phase-out of stavudine, age-appropriate non-zidovudine options are needed for younger Asian children with severe anemia.