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Comprehensive Pediatric Human Immunodeficiency Virus Care and Treatment in Constanta, Romania: Implementation of a Program of Highly Active Antiretroviral Therapy in a Resource-Poor Setting

Kline, Mark W. MD; Matusa, Rodica F. MD; Copaciu, Letitia MD; Calles, Nancy R. BSN, RN; Kline, Nancy E. PhD, RN, CPNP, FAAN; Schwarzwald, Heidi L. MD

Pediatric Infectious Disease Journal: August 2004 - Volume 23 - Issue 8 - pp 695-700
Special Article

Background: Relatively few human immunodeficiency virus (HIV)-infected children worldwide have access to care and treatment. The Romanian-American Children’s Center, a collaborative project of a U.S. health care institution and the Romanian government, has established a comprehensive program of highly active antiretroviral therapy for children in Constanta, Romania.

Objectives: To describe the design and outcomes of a program of pediatric HIV/acquired immunodeficiency syndrome (AIDS) care and treatment in a resource-poor setting.

Setting: Outpatient center providing comprehensive primary and HIV/AIDS specialty care and treatment to all known HIV-infected children living in Constanta County, Romania.

Outcomes: As of August 2003, a total of 452 children were receiving highly active antiretroviral therapy. Therapy has been well-tolerated, with ~90% of children continuing to receive treatment after a median duration of follow-up of 67 weeks. Normal weight and height growth velocities have been observed among treated children. Marked decreases have been observed in rates of hospitalization and mortality. The mean change in CD4+ lymphocyte count for 173 children who have both a baseline count and at least 1 follow-up count is +284 cells/μL (P < 0.0001).

Conclusions: Highly active antiretroviral therapy can be administered safely and effectively to children in a resource-poor setting, with outcomes comparable with those observed in U.S. pediatric antiretroviral clinical trials.

From the Department of Pediatrics, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX; and the Centrul de Copii Romano-American (Romanian-American Children’s Center), Constanta, Romania

Accepted for publication April 5, 2004.

Supported in part by the Abbott Laboratories Fund Step Forward program, the Sisters of Charity of the Incarnate Word, the Bristol-Myers Squibb Foundation, the U.S. Agency for International Development (Baylor grant 186-A-00-00-00113), the Fogarty International Center of the U.S.

National Institutes of Health (Baylor AIDS International Training and Research Program grant 5 D43 TW01036) and the National Institute of Allergy and Infectious Diseases (Baylor Center for AIDS research grant AI36211).

Address for reprints: Mark W. Kline, MD, Department of Pediatrics, Baylor College of Medicine, 6621 Fannin Street, CCC1570, Houston, Texas 77030. Fax 832-825-1281; E-mail mkline@texaschildrenshospital.org

© 2004 Lippincott Williams & Wilkins, Inc.