Monotherapy in an era of combination therapy: is there a benefit? Experience in HIV-1-infected symptomatic South African children

Abstract

We investigated the benefit of treating HIV-1-infected children with monotherapy where resources are limited. A retrospective chart review was undertaken in 12 symptomatic HIV-1-infected children treated with zidovudine or didanosine for at least 2 months. The main outcome measure was the effect on hospitalization. Anti-retroviral therapy was commenced in nine children because of prolonged or frequent hospitalization. Of three whose primary indication was bleeding secondary to thrombocytopenia, two had been hospitalized owing to severe intercurrent illness. One child had failure to thrive and another encephalopathy. Monotherapy was considered beneficial in all cases. Median duration of follow-up was 6.5 (2-31) months. The hospitalization index (days in hospital before and after start of monotherapy, divided by the total number of days before and after start of monotherapy) decreased from a median of 0.115 prior to therapy to 0.037 on therapy (p = 0.045, Wilcoxon matched pairs test). This study presents observational data supporting the investigation of monotherapy in resource-poor countries. It was associated with a significant reduction in hospitalization and appeared to result in clinical improvement. Prolonged or frequent hospitalization might represent a novel indication for use because in our setting the cost of hospitalization could potentially provide a 12-month-old infant with monotherapy for 2 months.

Vertically acquired paediatric HIV infection: the challenges of providing comprehensive packages of care in resource‐limited settings

“…Reductions in the burden on health‐care services have also been noted in developing countries; the median number of days in hospital (adjusted for follow‐up period) was significantly reduced in 12 symptomatic children in South Africa before and after zidovdine initiation (Pijnenburg & Cotton 2000), HAART in Jamaica reduced both the number of hospital admissions and the length of stay, with a mean difference after commencing therapy of ‐1.5 admissions ( P < 0.001) and a mean reduction in length of stay of 12.9 days ( P < 0.001) (Evans‐Gilbert et al. 2004).…”

Disease Progression in Children with Vertically-Acquired HIV Infection in Sub-Saharan Africa: Reviewing the Need for HIV Treatment

“…In one study investigating hospitalisation rates before and after zidovudine initiation in 12 severely symptomatic children in South Africa [72], a significant reduction in the median number of days in hospital (adjusted for follow-up period) 16 was found but no significant change in CD4% or WFA zscores; only one death was recorded making it difficult to reliably measure mortality. Fassinou et al [40] provide further evidence on 78 infected children receiving HAART in Côte d'Ivoire, showing significantly improved weight and a decreased incidence of clinical symptoms; after 12 months on treatment, probability of survival was 91%.…”