***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE . Few studies have investigated the efficacy of antiretroviral therapy among HIV-infected children in re source -poor setting s. This observational , retrospective analysis describes the clinical , immunologic , and virologic effects of highly active antiretroviral therapy in treatment-naive , HIV-infected children in Mombasa , Kenya . In keeping with a public health approach , all children were treated by using a simplified , nationally approved , triple-drug regimen . METHODS . Clinical data and stored plasma sample s from 29 children who were followed prospect ively between April 2003 and October 2004 were analyzed . All children received generic formulations of nevirapine , zidovudine , and lamivudine and were evaluated at baseline and at 3 , 6 , 9 , 12 , and 15 months . At each visit , weight and CD4 lymphocyte counts were measured and plasma sample s were stored for analysis . HIV RNA load was determined retrospectively at baseline and 9 months after initiation of therapy . RESULTS . The mean age of the children was 8.5 years ( range : 2–16 years ) . At baseline , the mean CD4 count ( ±SD ) was 182.3 × 106 cells per μL ( ±145.6 ) . On treatment , CD4 counts increased step-wise by a mean of 187 × 106 cells per μL at 3 months , 293 cells per μL at 6 months , 308 cells per μL at 9 months , 334 cells per μL at 12 months , and 363 cells per μL at 15 months . The mean plasma viral load decreased from a baseline level of 622 712 to 35369 copies per mL , and at 9 months was undetectable in 55 % of the patients . Mean z scores for weight for age increased from a baseline of −1.61 to −1.12 at 12 months into therapy . CONCLUSIONS . A public health approach using 1 treatment regimen in generic form showed excellent efficacy among treatment-naive , HIV-infected children in a re source -limited country . Clinical and immunologic improvement occurred in all patients , but 9 months after the start of therapy , only 55 % of the children had an undetectable viral load BACKGROUND Data are limited about the effectiveness of  pediatric antiretroviral therapy ( ART ) in low-income countries . METHODS We report the outcomes of consecutively treating 236 human immunodeficiency virus type 1 (HIV-1)-infected treatment-naive children with triple ART in Port-au-Prince , Haiti , between 1 May 2003 and 30 April 2006 . RESULTS Kaplan-Meier survival analysis at follow-up demonstrated that 191 children ( 81 % ) remained in care , 21 ( 9 % ) were dead , and 24 ( 10 % ) were lost to follow-up . Independent baseline predictors of mortality were age < 18 months , CD4(+ ) T cell percentage < or = 5 % , and weight-for-age Z score ( WAZ ) less than -3 . Twelve months into ART , 56 % of tested subjects had undetectable HIV-1 RNA loads . Median CD4(+ ) T cell percentages at 12 months increased by 15 % , 11 % , and 5 % in children with baseline percentages of < or = 5 % , 6%-24 % , and > or = 25 % , respectively ( P<.01 ) . The median WAZ at 12 months increased by 1.0 , 0.6 , and 0.2 in children with baseline WAZ less than -2 , -2 to -1.1 , and -1 or more , respectively ( P<.01 ) . CONCLUSION With continuous donor support , trained providers , and the availability of pediatric antiretroviral drug formulations , it proved feasible to deliver pediatric ART in Haiti . The effectiveness of this program should encourage efforts to make ART available for HIV-infected children in poor countries Background There are limited data of immunologic and virologic failure in Asian HIV-infected children using non-nucleoside reverse transcriptase inhibitor (NNRTI)-based highly active antiretroviral therapy ( HAART ) .  We examined the incidence rate of immunologic failure ( IF ) and virologic failure ( VF ) and the accuracy of using IF to predict VF in Thai HIV-infected children using first-line NNRTI-based HAART . Methods Antiretroviral (ART)-naïve HIV-infected children from 2 prospect i ve cohorts treated with NNRTI-based HAART during 2001 - 2008 were included .  CD4 counts were performed every 12 weeks and plasma HIV-RNA measured every 24 weeks . Immune recovery was defined as CD4%≥25 % . IF was defined as persistent decline of ≥5 % in CD4 % in children with CD4%<15 % at baseline or decrease in CD4 count ≥30 % from baseline . VF was defined as HIV-RNA>1,000 copies/ml after at least 24 weeks of HAART . Clinical and laboratory parameter changes were assessed using a paired t-test , and a time to event approach was used to assess predictors of VF . Sensitivity and specificity of IF were calculated against VF . Results 107 ART-naive HIV-infected children were included , 52 % female , % CDC clinical classification N : A : B : C 4:44:30:22 % . Baseline data were median ( IQR ) age 6.2 ( 4.2 - 8.9 ) years , CD4 % 7 ( 3 - 15 ) , HIV-RNA 5.0 ( 4.9 - 5.5 ) log10copies/ml . Nevirapine ( NVP ) and efavirenz (EFV)-based HAART were started in 70 % and 30 % , respectively . At 96 weeks , none had progressed to a CDC clinical classification of AIDS and one had died from pneumonia . Overall , significant improvement of weight for age z-score ( p = 0.014 ) , height for age z-score , hemoglobin , and CD4 were seen ( all p < 0.001 ) . The median ( IQR ) CD4 % at 96 weeks was 25 (18 - 30)% . Eighty-nine percent of children had immune recovery ( CD4%≥25 % ) and 75 % of children had HIV-RNA < 1.7log10copies/ml . Thirty five ( 32.7 % ) children experienced VF within 96 weeks . Of these , 24 ( 68.6 % ) and 31 ( 88.6 % ) children had VF in the first 24 and 48 weeks respectively . Only 1 ( 0.9 % ) child experienced IF within 96 weeks and the sensitivity ( 95%CI ) of IF to VF was 4 (0.1 - 20.4)% and specificity was 100 (93.9 - 100)% . Conclusion Immunologic failure , as defined here , had low sensitivity compared to VF and should not be recommended to detect treatment failure . Plasma HIV-RNA should be performed twice , at weeks 24 and 48 , to detect early treatment failure . Trial Registration Clinical trials.gov identification BACKGROUND Nevirapine-based antiretroviral therapy is the predominant ( and often the only ) regimen available for children in re source -limited setting s. Nevirapine resistance after exposure to the drug for prevention of maternal-to-child human immunodeficiency virus ( HIV ) transmission is common , a problem that has led to the recommendation of ritonavir-boosted lopinavir in such setting s. Regardless of whether there has been prior exposure to nevirapine , the performance of nevirapine versus ritonavir-boosted lopinavir in young children has not been rigorously established . METHODS In a r and omized trial conducted in six African countries and India , we compared the initiation of HIV treatment with zidovudine , lamivudine , and either nevirapine or ritonavir-boosted lopinavir in HIV-infected children 2 to 36 months of age who had no prior exposure to nevirapine .  The primary end point was virologic failure or discontinuation of treatment by study week 24 . RESULTS A total of 288 children were enrolled ; the median percentage of CD4 + T cells was 15 % , and the median plasma HIV type 1 ( HIV-1 ) RNA level was 5.7 log(10 ) copies per milliliter . The percentage of children who reached the primary end point was significantly higher in the nevirapine group than in the ritonavir-boosted lopinavir group ( 40.8 % vs. 19.3 % ; P<0.001 ) . Among the nevirapine-treated children with virologic failure for whom data on resistance were available , more than half ( 19 of 32 ) had resistance at the time of virologic failure . In addition , the time to a protocol -defined toxicity end point was shorter in the nevirapine group ( P=0.04 ) , as was the time to death ( P=0.06 ) . CONCLUSIONS Outcomes were superior with ritonavir-boosted lopinavir  among young children with no prior exposure to nevirapine .  Factors that may have contributed to the suboptimal results with nevirapine include elevated viral load at baseline , selection for nevirapine resistance , background regimen of nucleoside reverse-transcriptase inhibitors , and the st and ard ramp-up dosing strategy . The results of this trial present policymakers with difficult choices . ( Funded by the National Institute of Allergy and Infectious Diseases and others ; P1060 Clinical Trials.gov number , NCT00307151 . ) Growth failure is a common problem in HIV-infected children . The extent to which this growth failure could be reversed after the children receive antiretroviral therapy ( ART ) is not known . This study assessed the incidence of growth failure in HIV-infected Thai children , impact of ART on growth , and the predictors of growth reversal after initiating ART . Growth parameters and other characteristics were extracted from the data base of a prospect i ve cohort of HIV-infected children ( age < or=15 years ) who were enrolled to initiate non-nucleoside reverse transcriptase inhibitor-based ART between August 2002 and May 2007 .  Body weight and height measurements , CD4 cell counts , plasma HIV RNA levels were collected at baseline and 24-week intervals . A total of 225 HIV-infected children were included , 116 ( 51 % ) were males . The median age at baseline was 7.4 years ( interquartile range [ IQR ] 5.2 - 9.8 ) . Fifty-three percent were in Centers for Disease Control and Prevention ( CDC ) category C and 54 % had CD4 percentage 5 or less . The mean ( st and ard deviation [ SD ] ) of baseline weight-for-age ( WAZ ) and height-for-age ( HAZ ) z-scores were -2.02 ( 1.17 ) and -2.22 ( 1.51 ) . The median follow-up time was 216 weeks ( IQR 120 - 240 ) . The cumulative probability of growth reversal among the 179 subjects with growth failure at entry was 58 % ( 95 % confidence interval [ CI ] 49 - 67 ) at week 240 . In a multivariate Cox regression model , higher entry WAZ ( p < 0.001 ) and HAZ ( p < 0.001 ) , use of a nevirapine-based regimen ( compared to efavirenz , p = 0.027 ) and larger CD4 % gains to week 48 ( p < 0.001 ) were significant predictors of growth reversal after initiating ART . NNRTI-based ART leads to a substantial improvement in growth of HIV-infected children . Initiation of ART before the children developed growth failure should be encouraged OBJECTIVE To describe the outcomes of antiretroviral therapy ( ART ) in a large cohort of HIV-infected children in Thail and . METHODS The data were obtained from four collaborative referral sites around the country . Data from 2008 to March 2011 were collected prospect ively , and data before 2008 were collected retrospectively . RESULTS Of the 1139 children , 599 ( 52.6 % ) were female , and the duration of ART was a median 2.9 years ( interquartile range ( IQR ) 3.3 - 5.5 years ) . At ART initiation , the median age was 7.1 years ( IQR 3.4 - 10.0 years ) , CD4 percentage was 9.0 % ( IQR 3.0 - 17.0 % ) , and 61.3 % were in World Health Organization ( WHO ) stage 3 or 4 . Seventy-four percent were initiated on an NNRTI-based regimen . The death and lost to follow-up rates were 1.3 ( 95 % confidence interval ( CI ) 1.1 - 1.6 ) and 2.2 ( 95 % CI 1.6 - 2.6)/100 patient-years of follow-up , respectively . At the last clin 
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Younger cohort age was associated with greater growth reconstitution .
Protease inhibitor and nonnucleoside reverse-transcriptase inhibitor regimens yielded comparable growth .
Supplement benefits were attenuated after adjusting for baseline cohort growth .
RLS children had substantial growth deficits compared with developed setting s counterparts at ART ; growth shortfalls in RLS persisted despite reconstitution .
Earlier age and nutritional supplementation at ART may improve growth outcomes .