***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 The complexity of highly active antiretroviral therapy ( HAART ) , with multiple medications , formulations , and dosing intervals , makes adherence challenging . Little is known about the adherence of children to HAART . The objective of this study was to identify correlates of adherence to HAART and the relationship between adherence and study outcomes in a pediatric clinical trial . METHODS Pediatric AIDS Clinical Trials Group 377 is a phase I/II r and omized trial of 4 HAART regimens in antiretroviral-experienced , clinical ly stable children aged 4 months to 17 years . The 4 treatment arms include various 3- or 4-drug combinations of d4 T , 3TC , nevirapine , ritonavir , and nelfinavir . After informed consent was obtained , 193 children were enrolled between December 1997 and September 1998 . Question naires were developed to collect subject- or caregiver-reported adherence to study medications and to identify problems associated with medication administration . Every 3 months , the number of doses of each medication missed during the 3 days preceding the study visit was recorded . Full adherence ( FA ) and non-full adherence were defined as missing no doses and missing at least 1 dose , respectively . RESULTS Adherence data from study week 48 or the most recent study visit were available for 125 children ( week 48 for 109 children ) . Overall , 70 % of children reported FA and 30 % reported non-full adherence . Adherence did not differ by treatment arm , age , or the child 's knowledge of his or her human immunodeficiency virus infection status . There was a suggestion that adherence was less for white than nonwhite children ( 40 % vs 73 % FA ) and did not differ between black and Hispanic children .  Rates of FA were 82 % for d4 T , 79 % for 3TC , 83 % for nevirapine , 84 % for ritonavir , and 68 % for nelfinavir . Despite the similar rates of FA , difficulties with taking specific medications were reported most frequently for ritonavir and nelfinavir . These included poor taste , patient refusal , and scheduling problems . Adherence was associated with the virologic response : FA was seen in 92 % of children with > or = 2 log10 drop in viral load and in 64 % with < 2 log10 drop in viral load . CONCLUSION In children , reported adherence predicts the virologic response to HAART therapy and is a useful measure of adherence . Interventions and regimens to increase adherence to HAART should result in an improved outcome OBJECTIVE To describe the initial experience of treating HIV-infected children and their infected parents with antiretroviral therapy .  DESIGN Prospect i ve , 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 > or = 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 > or = 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 HIV-infected children in the public sector will benefit from antiretroviral therapy . However , both ambulatory and inpatient facilities are required to manage children on HAART comprehensively To assess efficacy and safety of fixed-dose combination ( FDC ) of lamivudine , stavudine and nevirapine in the treatment of pediatric HIV- infection , it was administered in the form of oral suspension ( Group-A ) or dispersible tablet ( Group-B ) . Assessment of improvement in symptoms , CD4 count and adverse drug reactions was done every three months . Baseline CD4 count/mm3 in Group-A ( n = 13 ) patients aged < or = 1 yr , 1 to 5 yr and > or = 6 yr increased by 79 , 152 , 342 , 988 ; 422.8 , 514.2 , 711.6 , 832.6 ; and 205 , 332.7 , 516.8 , 761.6 after 3 , 6 , 9 and 12 months of therapy , respectively . The corresponding baseline CD4 count/mm3 in Group-B ( n = 8) patients in the three age categories increased by 370 , 644.5 and 314 after 3 months , respectively . Improvement in the clinical category was observed in all the patients taking study medication , including weight gain ; and decreased incidence of fever , diarrhea , infections and hospitalization . None of the patients had any drug-related adverse effect . Adherence to the regimen was < 95 % and there were no treatment failures CONTEXT Clinical trials have established the efficacy of antiretroviral therapy with double- and triple-drug regimens for individuals infected with the human immunodeficiency virus ( HIV ) , but the effectiveness of these regimens in the population of patients not enrolled in clinical trials is unknown . OBJECTIVE To characterize survival following the initiation of antiretroviral therapy among HIV-infected individuals in the province of British Columbia . DESIGN Prospect i ve , population -based cohort study of patients with antiretroviral therapy available free of charge ( median follow-up , 21 months ) . SETTING Province of British Columbia , Canada . PATIENTS All HIV-positive men and women 18 years of age or older in the province who were first prescribed any antiretroviral therapy between October 1992 and June 1996 and whose CD4 + cell counts were less than 0.350 x 10(9)/L. MAIN OUTCOME MEASURES Rates of progression from initiation of antiretroviral therapy to death or a primary acquired immunodeficiency syndrome ( AIDS ) diagnosis for subjects who initially received zidovudine- , didanosine- , or zalcitabine-based therapy ( ERA-I ) and for those who initially received therapy regimens including lamivudine or stavudine ( ERA-II ) . RESULTS A total of 1178 patients ( 951 ERA-I , 227 ERA-II ) were eligible . A total of 390 patients died ( 367 ERA-I , 23 ERA-II ) , yielding a crude mortality rate of 33.1 % . ERA-I group subjects were almost twice as likely to die as ERA-II group subjects , with a mortality risk ratio of 1.86 ( 95 % confidence interval [ CI ] , 1.21 -2.86 ; P=.005 ) . After adjusting for Pneumocystis carinii and Mycobacterium avium prophylaxis use , AIDS diagnosis , CD4 + cell count , sex , and age , ERA-I participants were 1.93 times ( 95 % CI , 1.25 - 2.97 ; P=.003 ) more likely to die than ERA-II participants . Among patients without AIDS when treatment was started , ERA-I participants were 2.50 times ( 95 % CI , 1.59 - 3.93 ; P<.001 ) more likely to progress to AIDS or death than ERA-II participants . CONCLUSION The HIV-infected individuals who received initial therapy with regimens including stavudine or lamivudine had significantly lower mortality and longer AIDS-free survival than those who received initial therapy with regimens limited to zidovudine , didanosine , and zalcitabine BACKGROUND The study describes a cohort of HIV-infected Jamaican children receiving antiretroviral therapy ( ART )  and reports the outcome . METHOD An observational prospect i ve study was conducted on HIV-infected Jamaican children receiving anti retroviral drug therapy ( ART ) .  The outcome measures , weight , height , hospital admissions and length of stay were compared at initiation and within six months of commencing ART . RESULTS There were 37 ( 33.6 % ) of 110 HIV-infected children receiving ART during 2001 to 2003 . The median age at commencement was six years ( age range 1 - 16 years ) with 54.1 % ( 20 ) males and 48 % AIDS orphans . Care was home-based for 68 % of all cases with the University Hospital of the West Indies managing 27 ( 73 % ) and the Bustamante Hospital for Children 10 ( 27 % ) . The distribution by Centers for Disease Control and Prevention ( CDC ) clinical class was C ( severely symptomatic ) , 22 ( 59.5 % ) ; B ( moderately symptomatic ) , 8 ( 21.6 % ) ; A ( mildly symptomatic ) , 6 ( 16.2 % ) and N ( asymptomatic ) , one ( 2.7 % ) . Among 14 ( 36 % ) children with CD4 counts , 8 ( 57 % ) were CDC immune class 2 ( moderate immunodeficiency ) and 6 ( 43 % ) were class 3 ( severe immunodeficiency ) . After commencing ART the mean difference in admissions was--1.5+/-2.55 admissions ( 95 % CI -2.3 , -0.6 ; p < 0.001 ) and in length of stay was -12.9+/-21 day ( 95 % CI -19.9 , -0.5.9 ; p < 0.001 ) . Antiretroviral therapy result ed in a mean weight gain of 2.8 kg+/-4.9 kg ( 95 % CI 1.0 , 4.5 ; p < 0.003 ) and a mean gain in height of 1.7 cm+/-2.6 cm ( 95 % CI 0.6 , 2.8 ; p < 0.003 ) . Five children required second line therapy . CONCLUSION The introduction of antiretroviral therapy has result ed in improved outcomes and is being initiated in older children cared for mainly at home . Limitations in accessing affordable second line agents underscore the need for compliance with first line therapy OBJECTIVES To evaluate the feasibility , duration of efficacy , and outcome of therapy with dual nucleoside reverse transcriptase inhibitors ( NTRI ) initiated in HIV-infected infants with mild to moderate disease . MATERIAL AND METHOD During 1998 - 2000 , a multi-center prospect i ve open-labeled operational study was conducted . Antiretroviral naôve HIV-infected infants were enrolled in seven hospitals to receive either zidovudine ( AZT ) plus lamivudine ( 3TC ) or AZT plus didanosine ( ddI ) .  Infants who were in CDC stage " C3 " were excluded from the study . RESULTS Of the 88 infants , the mean age of treatment initiation was 6.8 months , and the mean initial CD4 was 1538 cells/mm3 ( 21.4 % ) . The z-scores for weight and height increased after 4 - 8 months of treatment , and by the 24th month , were + 0.89 and + 0.69 higher than at enrollment . The CD4 % peak increased at 8 months of treatment , by a mean increment of 4.19 % , but decreased to the level of 1.08 % above baseline by the 24th month of treatment . Three ( 3.4 % ) infants died , 11 ( 12 % ) had disease progression , 7 ( 8 % ) was prematurely discontinued from the study protocol due to poor compliance , and 37 ( 42 % ) were lost to follow-up . At the end of 24 months , all remaining 30 children were in stable condition with a chance of clinical and immunological stability of 34 % and 68 % by intention-to-treat and on-treatment analysis , respectively . CONCLUSION Clinical and immunological benefit from dual NRTI was limited . Treatment of HIV-infected infant with mild to moderate disease in a re source -limited setting may have limited feasibility due to 
    Output:
    
Pill counts revealed lower adherence estimates .
Pediatric HIV care programs in low- and middle-income countries use heterogeneous methods to measure ART adherence .