OBJECTIVE: To describe the response of children during their first year on highly active antiretroviral therapy (HAART). DESIGN: Retrospective, descriptive. SETTING: Tertiary, referral hospital. SUBJECTS: All HIV-infected children commenced on HAART from 1 August 2002 until 31 December 2004. OUTCOME MEASURES: Children were retrospectively restaged using the WHO 4-stage clinical classification and CDC immunological staging system. After commencing HAART, patients were assessed at monthly intervals for the first 6 months and thereafter mostly 3-monthly. Baseline and 6- monthly CD4 counts and viral loads were performed. RESULTS: Of 409 children commenced on HAART, 50.6 were or = 1 million copies/ml (adjusted HR: 1.84 (95 CI 1.03 - 3.29)) and taking a protease inhibitor (PI)-based regimen (adjusted HR: 2.25 (95 CI 1.10 - 4.61)) were additionally independently associated with poorer survival; however, young age was not a significant predictor of mortality, after adjusting for viral load (p = 0.119). After 1 year of HAART 184/264 (69.7) of children had a viral load < 400 copies/ml. Comparative analysis showed significant improvements in growth, immunological status and virological control. CONCLUSION: HAART can improve the health of many HIV-infected children with advanced disease, including those aged less than 2 years in resource-limited settings.
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