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BackgroundDelays in early infant diagnosis and antiretroviral treatment (ART) initiation in developing countries frequently result in malnutrition at initial presentation with associated higher mortality and delayed immune recovery. The optimal timing of ART initiation is yet to be established.MethodsEighty-two children admitted with HIV and severe acute malnutrition (SAM) between July 2012 and December 2015 were enrolled. Patients were randomized to initiate ART within 14 days from admission (early arm) or delay ART initiation until nutritional recovery and >14 days after admission (delayed arm). All patients received a standardized treatment and feeding protocol and were followed to 48 weeks.ResultsThe mean age of the patients at baseline was 23.3 months (standard deviation [SD], 27.9; range, 1.6-129 months). The mean time from admission to ART initiation was 5.6 days (SD, 4.4) in the early arm and 23 days (SD, 5.8) in the delayed arm (P ConclusionsDespite initial improved responses in the delayed arm, lack of difference in outcome at 48 weeks supports a pragmatic approach with earlier ART initiation in children living with HIV admitted with SAM.In this randomised controlled study of ART initiation in children admitted with HIV and severe acute malnutrition (SAM), despite initial improved responses in the delayed arm, lack of difference in outcome at 48 weeks supports a pragmatic approach with earlier ART initiation in children living with HIV admitted with SAM.Clinical trials registrationPACTR 21609001751384.

Original publication

DOI

10.1093/jpids/piaa054

Type

Journal

Journal of the Pediatric Infectious Diseases Society

Publication Date

04/2021

Volume

10

Pages

259 - 266

Addresses

Paediatric Unit, King Edward VIII Hospital, Durban, South Africa.

Keywords

Humans, HIV, HIV Infections, Anti-Retroviral Agents, Viral Load, Child, Child, Preschool, Infant, Severe Acute Malnutrition