(HIV)-infected children in resource-limited

Responses to antiretroviral therapy (ART) among human immunodeficiency virus (HIV)-infected children in resource-limited settings have recently been reported, but outcomes vary. The authors sought to derive pooled estimates of the 12-month rate of virologic suppression (HIV RNA, <400> (DeltaCD4%) for children initiating antiretroviral therapy in resource-limited settings. Ciaranello et al conducted a systematic review and meta-analysis of published reports of HIV RNA and CD4 outcomes for treatment-naive children aged 0-17 years old by means of the Medline, EMBASE (Excerpta Medica Database), and LILACS (Latin American and Caribbean Health Sciences Literature) electronic databases and the Cochrane Clinical Trials Register. Pooled estimates of the reported proportion with HIV RNA <400>400 copies/mL or DeltaCD4% of zero. In patient-level estimates after 12 months of antiretroviral therapy, the pooled proportion with virologic suppression was 70% (95% confidence interval [CI], 67%-73%); the pooled DeltaCD4% was 13.7% (95% CI, 11.8%-15.7%). Results from the fixed- and random-effects models were similar. In approximated intention-to-treat analyses, the pooled estimates decreased to 53% with virologic suppression (95% CI, 50%-55%) and to a DeltaCD4% of 8.5% (95% CI, 5.5%-11.4%). Pooled estimates of reported virologic and immunologic benefits after 12 months of antiretroviral therapy among HIV-infected children in resource-limited settings are comparable with those observed among children in developed settings. Consistency in reporting on reasons for missing data will aid in the evaluation of antiretroviral therapy outcomes in resource-limited settings.

Treatment outcomes for treatment-naïve children after 1 year are similar in resource-poor settings as they are in the United States of America and Europe, despite advanced stages of HIV disease at initiation of antiretroviral treatment, substantial barriers to service delivery, and predominantly non-nucleoside reverse transcriptase inhibitor (NNRTI)-based regimens. This is great news from this first study to provide pooled estimates of the virological suppression rate and change in CD4 percentage in children in countries with emerging or developing economies. These findings have particular importance for the estimated 90% of children living with HIV who reside in resource-limited settings and should spur on the movement to treat all children living with HIV.