Browsing by Author "Smith, Lara"
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- ItemOpen AccessInitial experience of a public sector antiretroviral treatment programme for HIV-infected children and their infected parents(2004) Eley, Brian; Nuttall, James; Davies, Mary-Ann; Smith, Lara; Cowburn, Carol; Buys, Heloise; Hussey, GregoryObjective. To describe the initial experience of treating HIVinfected children and their infected parents with antiretroviral therapy. Design. Prospective, cohort study. Setting. Tertiary, referral hospital. Patients. HIV-infected children and their parents. Methods. This report focuses on the early response of children to highly active antiretroviral therapy (HAART). Children were followed up at 4-weekly intervals. Monitoring included initial and yearly viral load measurements, baseline and 6- monthly CD4 counts and 4-weekly adherence checks. Results. Between August 2002 and June 2003, 80 children were enrolled in the programme, representing a follow-up period of 23.9 patient-years. Seventy-five children had severe clinical disease, severe immune suppression, or a combination of the two. The response of children who had received HAART for ≥ 6 months (N = 17) was assessed. There was no change in mass z-score (p = 0.11) or length z-score (p = 0.37), but a significant increase in CD4 percentage (p < 0.0001) during the first 6 months of therapy. Six-month viral loads were available for 12 children. There was a significant drop in viral load (p = 0.001) and 9 achieved undetectable levels by 6 months. Most children achieved ≥ 85% adherence. By June 2002, 67 children (84%) were relatively well, 1 had B-cell lymphoma, 7 (8.8%) had died, 4 (5%) were lost to follow-up and 1 was withdrawn from the programme. Of 57 children who completed 3 months of HAART, 12 were admitted a total of 17 times for infectious complications. There were no severe drug reactions. Three of 7 mothers on HAART received treatment through the programme. Conclusion. These initial results suggest that many HIVinfected children in the public sector will benefit from antiretroviral therapy. However, both ambulatory and inpatient facilities are required to manage children on HAART comprehensively
- ItemOpen AccessNeurocognitive outcome of HIV-infected children on antiretroviral therapy at Red Cross Children's Hospital(2004) Smith, Lara; Adnams, Colleen; Eley, BrianCentral nervous system involvement contributes significantly to the morbidity and mortality of paediatric HIV infection. The spectrum of CNS morbidity varies from minor developmental disabilities to severe, progressive encephalopathy. Therefore regular developmental evaluation should be regarded as an essential component of the overall care of HIV-infected children. Antiretroviral therapy may arrest or even reverse neurocognitive and motor deficits associated with HIV infection.
- ItemOpen AccessNeurological and neurocognitive function of HIV-infected children commenced on antiretroviral therapy(Health & Medical Publishing Group, 2008) Smith, Lara; Adnams, Colleen; Eley, BrianAim: To describe neurological and neurocognitive deficits in HIV-infected children and the short-term effect of highly active antiretroviral therapy (HAART) on the observed deficits. Methods: In this prospective study, 39 children (15 females) were evaluated before the start of HAART and 30 reassessed 6 months later. The subjects were evaluated with a range of cognitive tests used in everyday clinical practice. Results: At enrolment, the mean (±SD) age was 60±46 months, 17 (44%) and 22 (56%) had Centers for Disease Control (CDC) clinical category B and C disease respectively, and 36 (92%) had severe immunosuppression. At the start of HAART no child had cranial nerve or cerebellar dysfunction, but 13/29 (33.3%) had evidence of motor dysfunction. By 6 months 1 child had developed cerebellar dysfunction, but there was no statistically significant change in the frequency of motor dysfunction. Mean baseline performances on cognitive testing were generally subnormal. Between 33% and 81% of the children recorded subnormal intelligence quotients on various cognitive tests. Mean performances did not change significantly after 6 months of HAART. Conclusion: Neurological and neurocognitive deficits are frequent in HIV-infected children. The prevalence and extent of deficits did not change significantly in response to short-term HAART, indicating neither spontaneous improvement nor deterioration during early treatment.