Outcomes of HIV-Infected Orphaned and Non-Orphaned Children on Antiretroviral Therapy in Western Kenya

The objectives were to 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. 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. 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. (authors)