Immediate vs Deferred Antiretroviral Therapy in Children with HIV
Author Information
Author(s): Jintanat Ananworanich, Pope Kosalaraksa, Umaporn Siangphoe, Chulapan Engchanil, Chitsanu Pancharoen, Jintana Intasan, Wichitra Apateerapong, Theshinee Chuenyam, Sasiwimol Ubolyam, Torsak Bunupuradah, Joep Lange, David A Cooper, Praphan Phanuphak
Primary Institution: The HIV Netherlands Australia Thailand Research Collaboration (HIV-NAT)
Hypothesis
With close follow up and CD4 monitoring, ART can be deferred until CD4 < 15% in children ages 1 to 12 years old without affecting HIV disease progression.
Conclusion
Almost 40% of children were not eligible due mainly to low CD4%, but adherence to randomized treatment and retention in trial were excellent.
Supporting Evidence
- Recruitment took 15 months, with 37.7% of screened children not eligible due to low CD4%.
- All children accepted the randomized arm, with high adherence and retention rates.
- No child had AIDS or death during the study period.
Takeaway
The study looked at whether starting HIV treatment right away or waiting until the child's health got worse was better. It found that waiting was safe for some kids.
Methodology
An open-label pilot randomized clinical trial was conducted with 43 Thai children, comparing immediate and deferred ART based on CD4 levels.
Potential Biases
No significant bias risks were reported.
Limitations
The small sample size limits the ability to show differences in clinical efficacy and safety between the two treatment strategies.
Participant Demographics
Median age was 4.8 years, with 17 males and 26 females; most had CDC A clinical disease.
Statistical Information
P-Value
p=0.012
Confidence Interval
95% CI 3.3 – 9.9
Statistical Significance
p<0.05
Digital Object Identifier (DOI)
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