HIV-infected children in the Asia-Pacific region with baseline severe anemia: antiretroviral therapy and outcomes

Lumbiganon P 1 , Kosalaraksa P 1 , Bunupuradah T 2 , Boettiger D 3 , Saphonn V 4 , Truong KH 5 Show all authors , Kurniati N 6 , Hansudewechakul R 7 , Do VC 8 , Sudjaritruk T 9 , Kumarasamy N 10 , Kongstan N 11 , Yusoff NK 12 , Nguyen LV 13 , Wati DK 14 , Razali K 15 , Sohn AH 16 , Kariminia A 3

Affiliations 

  • 1 Division of Infectious Diseases, Department of Pediatrics, Khon Kaen University, Khon Kaen 40002, Thailand
  • 2 HIV-NAT, the Thai Red Cross AIDS Research Centre, Bangkok 10330, Thailand
  • 3 The Kirby Institute, University of New South Wales, Sydney, NSW 2052, Australia
  • 4 National Centre for HIV/AIDS, Dermatology and STDs (NCHADS), Phnom Penh, Cambodia
  • 5 Children's Hospital 1, Ho Chi Minh City, Vietnam
  • 6 Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
  • 7 Chiangrai Prachanukroh Hospital, Chiang Rai 57000, Thailand
  • 8 Children's Hospital 2, Ho Chi Minh City, Vietnam
  • 9 Department of Pediatrics, Faculty of Medicine, Chiang Mai University and Research Institute for Health Sciences, Chiang Mai 50200, Thailand
  • 10 YRG CARE Medical Centre, CART CRS, Chennai, India
  • 11 Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
  • 12 Hospital Raja Perempuan Zainab II, Kelantan 15000, Malaysia
  • 13 National Hospital of Pediatrics, Hanoi, Vietnam
  • 14 Sanglah Hospital, Udayana University, Bali, Indonesia
  • 15 Paediatric Institute Hospital Kuala Lumpur, Kuala Lumpur 50586, Malaysia
  • 16 TREAT Asia/amfAR-The Foundation for AIDS Research, Bangkok 10330, Thailand
Asian Biomed (Res Rev News), 2016 Jun;10(3):229-234.
PMID: 28239430

Abstract

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.

CONCLUSIONS: With the phase-out of stavudine, age-appropriate non-zidovudine options are needed for younger Asian children with severe anemia.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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