Clinical Course And Outcome Of HIV Positive Children Resident At A Children’s Home In Nairobi: A 15 Year Review (1995-2010)

Abstract

Background: Availability of antiretroviral therapy (ART) has changed the outcome of HIV. Prior to 2005 drug supply was erratic, paediatric formulations difficult to get and costs were prohibitive. Method: The current is a retrospective report on outcome 207 HIV infected children we have consistently followed up clinically since 1995, immunological and virology since 1998 and ART since 1999. Results: Out of the 207 children 146 (70.5%) are alive, and 61 (29.5%) have died. Mean age at admission was 4.7yrs (range 2 months to 14yrs) and end of 2010 mean age was 14yrs (range of 2yrs to 24yrs) Most of the deaths were in the period before availability of ARVs. Eleven of the 17 children who died after 2000 were on ART. At the start of therapy 71 (63.4%) had WHO stage 3/4 disease. The most common condition was chronic lung disease 36 (32.1%). Majority of children improved clinically and immunologically. But CD4 counts remained low for age in 16 children. Since the start of ART, 57 children are on first line drugs while 55 are on second line and 20 are not on treatment. Viral load of children on first line became undectable within 6 months in 66.7% while others took up to 24 months. Forty six children who never responded to first line drugs despite clinical and immunological response had resistant mutations.