The Sindh AIDS Control Program (SACP) in Pakistan began dispensing combination antiretroviral therapy (ART) in May 2006 in Karachi. This study aimed to assess the management and outcomes of ART-treated patients. Data were extracted from medical records of adult patients registered with the SACP who received ART between May 2006 and May 2010. In total, 300 patients received ART, of whom 77.7% were men. The median CD4 cell count at the time of joining the SACP was 130 cells/mm(3). ART was nevirapine-based in 69.1% of cases and was correctly prescribed in 97.3%. Of 257 patients who received ≥1 month of ART, >90% were regular with their medications and appointments. Of the 300 patients, 70 (23.3%) had HIV-related deaths and 4 (1.3%) had non-HIV-related deaths, whereas 32 (10.7%) transferred out and 16 (5.3%) stopped attending the clinic and could not be traced. Estimated survival in the first 6 months stratified by initial CD4 lymphocyte count ≥50 cells/mm(3) and <50 cells/mm(3) was 85.8% (95% CI 80.8-90.0%) and 52.2% (95% CI 40.9-63.1%), respectively. Viral suppression was achieved in 95.4% of those who survived beyond 3 months of starting ART. ART can be managed adequately with excellent patient adherence and satisfactory clinical outcomes in a resource-limited setting.

Introduction: The impact of antiretroviral (ARV) therapy on immunological and growth parameters in HIV-positive children in Pakistan has not been reported to date. Methodology: A retrospective chart review of children diagnosed with HIV at the Sindh AIDS Control Proigramme (SACP) and registered at the Aga Khan University, Karachi, between January 2005 and 2013 was conducted, evaluating clinical and laboratory profiles of HIV+ ARV+ children for ARV impact (serial height and weight CD4 and viral counts). Results: Twenty-four children were diagnosed and registered as HIV positive over five years, and 20 were started on ARV. Six were excluded from analysis (ARV duration < 6 months). Nine (64.3%) of 14 fulfilled WHO criteria for treatment failure at a median duration of 25 weeks (IQR 18-32) on ARV and underwent resistance genotyping. All nine had NNRTI resistance, two had high-grade NRTI resistance (≥ 4 thymidine analog mutations). Median age at start of ARV was 71.5 weeks (IQR 37.5-119). Median baseline weight for age (WAZ) and height for age (HAZ) z-scores changed from -1.94 to 1.69 and -1.99 to -1.59, respectively, after six months of therapy. Median CD4 percentage and viral load at baseline changed from 13.8 to 17.8, while viral load changed from 285 × 10 4 copies to zero at six months. Conclusions: ARV improved absolute CD4 and viral counts. Weight and height did not improve significantly, highlighting the need for aggressive nutritional rehabilitation. Early development of ARV resistance in these children requires formal assessment.