Antiretroviral therapy for children in the routine setting in Malawi

Malawi is scaling up antiretroviral therapy (ART) for HIV-infected patients. Using a fixed-dose combination of stavudine + lamivudine + nevirapine ('Triomune') as the first-line regimen, split tablets are given to children with doses according to body weight. By March 2006, a total of 46 702 patients had been started on ART, of whom 2718 (5.8%) were children aged <15 years. In a subset of 935 children, comprising 486 boys and 449 girls, 1.5% were aged <1 year, 26% were aged 1-4 years, 39% were aged 5-9 years and 33% were aged 10-14 years. Between July and September 2005, 7905 patients started ART, comprising 7469 adults and 436 children. Six-month cohort outcomes censored on 31 March 2006 showed significantly more children alive and significantly fewer children dead or defaulted compared with adults. Between January and March 2005, 4580 patients started ART, comprising 4347 adults and 233 children. Twelve-month cohort outcomes censored on 31 March 2006 showed significantly more children alive compared with adults. The results of this national study should encourage other programmes to invest in ART for children and particularly to monitor their treatment outcomes.