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Feasibility and effectiveness of combination antiretroviral therapy in HIV-infected infants in Pietermaritzburg, South Africa


In the absence of treatment, 50% of HIV-infected children will die before 2 years of age. In a recent randomized controlled trial, a 76% decrease in mortality was observed in infants receiving early combination antiretroviral therapy [1]. The World Health Organization now recommends starting all HIV-infected infants on combination antiretroviral therapy on diagnosis [2]. However, few data are available outside a well-controlled research setting.

Purpose of the study

To show the feasibility and effectiveness of treating HIV-infected infants in a state-funded clinic located in a poorly resourced South African township.


A retrospective chart review was performed of all HIV-1 infected infants initiated on combination antiretroviral therapy (cART) between 1st May 2005 and 31st May 2008 at the Edendale Family Clinic, Pietermaritzburg, South Africa. All HIV-1 infected infants who were less than 1 year of age when antiretroviral therapy was initiated, and who had completed at least 6 months of treatment, were included. Weight for age Z scores, CD4 %, viral loads (VL) and haemoglobin were collected on initiation of treatment and at 6-monthly intervals thereafter. Virological success was defined as VL<25 copies/ml, immune recovery as CD4>25%. Z scores were analyzed using Epi-Info.

Summary of results

Of 129 treated infants, 94 completed 6 months of cART; 60 completed 12 months and 39 completed 18 months of treatment. Mean age at initiation was 8 months (range 2.1-11.7). 77.2% had advanced disease (WHO Stage 3 or 4). The infants were severely malnourished, with a mean Z-score of -2.4 (range -6.1 - +0.8). Mean baseline VL was 4700 000 copies/ml. After 6 months of treatment, 52.3% of babies had an undetectable VL, with 75% having a VL of < 400 copies/ml. Viral suppression was achieved in 34 (56.9%) out of the 60 infants who completed 1 year of cART and 79.3% had a VL <400 copies/ml. Undetectable VL was found in 78.8% of the 39 children who received 18 months of treatment. Weight for age Z score increased from a mean of -2.4 (<3rd centile) at initiation of treatment to -0.3 (38th centile) for the children who received 18 months of cART. The CD4% increased from a mean of 16.5% at the start to 31.9% at 18 months.


This study from a township in Kwazulu-Natal shows a good clinical, immunological and virological response to cART in HIV-infected infants, despite high baseline viral loads and advanced disease.


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This article is published under license to BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Van der Linden, D., Purchase, S. & McKerrow, N. Feasibility and effectiveness of combination antiretroviral therapy in HIV-infected infants in Pietermaritzburg, South Africa. JIAS 13 (Suppl 4), P154 (2010).

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