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Few data are available on the outcomes of pediatric antiretroviral therapy (ART) in the developing world.Eighty-three children were followed prospectively in China from July 2005 to August 2006 and received (zidovudine or stavudine) plus lamivudine plus (nevirapine or efavirenz).Fifty-one children were ART naive at enrollment, and 32 were ART experienced. After 12 months, median weight increased by 0.3 weight for age z-score, median CD4 count increased from 116 to 340 cells/mm3 (P < 0.0001), and median viral load decreased from 5.53 to <2.60 log10 copies/mL (P < 0.0001) in the previously ART-naive children. In the ART-experienced children, median CD4 count increased from 193 to 318 cells/mm3 (P = 0.13), despite little change in median viral load (4.85 to 4.58 log10 copies/mL; P = 0.83). The viral load was <400 copies/mL in 55% of the previously ART-naive children and in 16% of the ART-experienced children.Weight and CD4 cell counts improved, and more than half of previously ART-naive patients had undetectable viral loads at 1 year. Future efforts should focus on improved virologic suppression through improved adherence and access to second-line regimens.