Abstract:
Objectives: Determine outcome differences between orphaned and
non-orphaned children receiving antiretroviral therapy (ART).
Design: Retrospective review of prospectively recorded electronic
data.
orphan
Setting: Nine HIV clinics in western Kenya.
Population: 279 children on ART enrolled between August 2002
and February 2005.
Main Measures: Orphan status, CD4%, sex- and age-adjusted
height (HAZ) and weight (WAZ) z scores, ART adherence, mortality.
Results: Median follow-up was 34 months. Cohort included 51%
males and 54% orphans. At ART initiation (baseline), 71% of
children had CDC clinical stage B or C disease. Median CD4% was
9% and increased dramatically the first 30 weeks of therapy, then
leveled off. Parents and guardians reported perfect adherence at every
visit for 75% of children. Adherence and orphan status were not
significantly associated with CD4% response. Adjusted for baseline
age, follow-up was significantly shorter among orphaned children
(median 33 vs. 41 weeks, P = 0.096). One-year mortality was 7.1%
for orphaned and 6.6% for non-orphaned children (P = 0.836). HAZ
and WAZ were significantly below norm in both groups. With ART,
HAZ remained stable, while WAZ tended to increase toward the norm,
especially among non-orphans. Orphans showed identical weight gains
as non-orphans the first 70 weeks after start of ART but experienced
reductions afterwards.
