Monotherapy in an era of combination therapy: is there a benefit? Experience in HIV-1-infected symptomatic South African children

We investigated the benefit of treating HIV-1-infected children with monoth erapy where resources are limited. A retrospective chart review was underta ken in 12 symptomatic HIV-1-infected children treated with zidovudine or di danosine for at least 2 months. The main outcome measure was the effect on hospitalization. Anti-retroviral therapy was commenced in nine children bec ause of prolonged or frequent hospitalization. Of three whose primary indic ation was bleeding secondary to thrombocytopenia, two had been hospitalized owing to severe intercurrent illness. One child had failure to thrive and another encephalopathy. Monotherapy was considered beneficial in all cases. Median duration of follow-up was 6.5 (2 - 31) months. The hospitalization index (days in hospital before and after start of monotherapy, divided by t he total number of days before and after start of monotherapy) decreased fr om a median of 0.115 prior to therapy to 0.037 on therapy (p=0.045, Wilcoxo n matched pairs test). This study presents observational data supporting th e investigation of monotherapy in resource-poor countries. It was associate d with a significant reduction in hospitalization and appeared to result in clinical improvement. Prolonged or frequent hospitalization might represen t a novel indication for use because in our setting the cost of hospitaliza tion could potentially provide a 12-month-old infant with monotherapy for 2 months.