Outcome of anti-retroviral treatment in HIV-infected orphans and non-orphans at an ART centre in North India

Background: Few Indian studies have reported the long-term efficacy of anti-retroviral treatment ( ART) in children and in orphaned, HIV-infected children in particular. Aim: To study differences in outcome of ART in HIV-infected orphans compared with non-orphans. Methods: A retrospective study of 87 HIV-infected children who commenced ART in the period January 2006 to August 2007. The main measures were orphan status, absolute CD4 count and weight-for-height (WHZ) and height-for-age (HAZ) Z-scores. Results: Median follow-up was 33 months. Forty (45.9%) children were orphaned. Orphans and non-orphans had similar baseline median WHZ and HAZ (-2.48 vs -2.63, P=0.65 and -2.78 vs -2.91, P=0.77, respectively). The two groups were similar in terms of WHO clinical stage and frequency of severe immunosuppression at presentation (P=0.88 and 0.25, respectively). After ART initiation, the median absolute CD4 count increased progressively in both groups. Median WHZ and HAZ increased throughout the study period in the orphans and reached 21 at 27 and 39 months of ART, respectively. In the non-orphans, WHZ remained below that of the orphan group, the difference becoming statistically significant from 18 months of ART. The increment in HAZ in the non-orphan group was at par with the orphan group until 12 months of follow-up, after which it fell between 18 and 30 months. Subsequently, HAZ rose but remained below that of the orphan group. Both WHZ and HAZ failed to reach 21 in the non-orphan group. In both groups, 85% reported 100% adherence to ART. Conclusion: The outcome of ART is not affected by orphan status with the extended family adequately supporting orphaned children. Growth of children whose parents are HIV-infected may be constrained despite ART if there is inadequate family support.