1
|
Aurpibul L, Kariminia A, Vibol U, Fong MS, Le ON, Hansudewechakul R, Bunupuradah T, Kurniati N, Chokephaibulkit K, Kumarasamy N, Wati DK, Yusoff NKN, Razali KAM, Nallusamy RA, Sohn AH, Lumbiganon P. Seroprevalence of Hepatitis B Among HIV-infected Children and Adolescents Receiving Antiretroviral Therapy in the TREAT Asia Pediatric HIV Observational Database. Pediatr Infect Dis J 2018; 37:788-793. [PMID: 29846357 PMCID: PMC6097529 DOI: 10.1097/inf.0000000000001901] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Hepatitis B (HBV)-HIV coinfection is associated with liver inflammation, which can progress to liver fibrosis/cirrhosis and hepatocellular carcinoma. We determined HBV seroprevalence in children and adolescents participating in the TREAT Asia Pediatric HIV Observational Database. METHODS A multisite cross-sectional study was conducted in HIV-infected patients currently <25 years old receiving antiretroviral treatment (ART) who had HBV surface antigen (HBsAg), or HBV surface antibody (anti-HBs) or HBV core antibody (anti-HBc) tested during 2012-2013. HBV coinfection was defined as having either a positive HBsAg test or being anti-HBc positive and anti-HBs negative, reflective of past HBV infection. HBV seroprotection was defined as having a positive anti-HBs test. RESULTS A total of 3380 patients from 6 countries (Vietnam, Thailand, Cambodia, Malaysia, Indonesia and India) were included. The current median (interquartile range) age was 11.2 (7.8-15.1) years. Of the 2755 patients (81.5%) with HBsAg testing, 130 (4.7%) were positive. Of 1558 (46%) with anti-HBc testing, 77 (4.9%) were positive. Thirteen of 1037 patients with all 3 tests were anti-HBc positive and HBsAg and anti-HBs negative. One child was positive for anti-HBc and negative for anti-HBs but did not have HBsAg tested. The prevalence of HBV coinfection was 144/2759 (5.2%) (95% confidence interval: 4.4-6.1). Of 1093 patients (32%) with anti-HBs testing, 257 (23.5%; confidence interval: 21.0-26.0) had positive tests representing HBV seroprotection. CONCLUSIONS The estimated prevalence of HBV coinfection in this cohort of Asian HIV-infected children and adolescents on ART was 5.2%. The majority of children and adolescents tested in this cohort (76.5%) did not have protective HBV antibody. The finding supports HBV screening of HIV-infected children and adolescents to guide revaccination, the use of ART with anti-HBV activity and future monitoring.
Collapse
Affiliation(s)
- Linda Aurpibul
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
| | | | - Ung Vibol
- University of Health Sciences and National Pediatric Hospital, Phnom Penh, Cambodia
| | | | - Oanh Ngoc Le
- Worldwide Orphans Foundation, Ho Chi Minh City, Vietnam
| | | | | | - Nia Kurniati
- Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Kulkanya Chokephaibulkit
- Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | | | | | | | | | - Annette H Sohn
- TREAT Asia/amfAR – The Foundation for AIDS Research, Bangkok, Thailand
| | - Pagakrong Lumbiganon
- Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| |
Collapse
|
2
|
Low YS, Islahudin F, Razali KAM, Adnan S. Modification of Initial Highly Active Antiretroviral Therapy (HAART) Regimen in Paediatric HIV Patients. Open AIDS J 2018; 12:11-19. [PMID: 29576815 PMCID: PMC5850481 DOI: 10.2174/1874613601812010011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Revised: 10/11/2017] [Accepted: 01/30/2018] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Treatment options among Human Immunodeficiency Virus (HIV)-infected children are limited as only a few Highly Active Antiretroviral Therapy (HAART) are approved worldwide for paediatric use. Among children, frequent changes in HAART regimen can rapidly exhaust treatment options, and information addressing this issue is scarce. OBJECTIVE The aim of the study was to determine factors associated with the modification of initial HAART regimen modification among HIV-infected children. METHOD A retrospective study was performed among HIV-infected children aged 18 and below, that received HAART for at least six months in a tertiary hospital in Malaysia. Factors associated with modification of initial HAART regimen were investigated. RESULTS Out of 99 patients, 71.1% (n=71) required initial HAART regime modification. The most common reason for HAART modification was treatment failure (n=39, 54.9%). Other reasons included drug toxicity (n=14, 19.7%), change to fixed-dose products (n=11, 15.5%), product discontinuation (n=4, 5.6%) and intolerable taste (n=3, 4.2%). The overall mean time retention on initial HAART before regimen modification was 3.32 year ± 2.24 years (95% CI, 2.79-3.85). Patient's adherence was the only factor associated with initial regimen modification in this study. Participants with poor adherence showed a five-fold risk of having their initial HAART regimen modified compared to those with good adherence (adjusted OR [95% CI], 5.250 [1.614 - 17.076], p = 0.006). CONCLUSION Poor adherence was significantly associated with initial regimen modification, intervention to improve patient's adherence is necessary to prevent multiple regimen modification among HIV-infected children.
Collapse
Affiliation(s)
- Yee Shan Low
- Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur, Malaysia
| | - Farida Islahudin
- Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur, Malaysia
| | | | - Shafnah Adnan
- Hospital Kuala Lumpur, Jalan Pahang, 50586 Kuala Lumpur, Malaysia
| |
Collapse
|
3
|
Prasitsuebsai W, Sethaputra C, Lumbiganon P, Hansudewechakul R, Chokephaibulkit K, Truong KH, Nguyen LV, Mohd Razali KA, Nik Yusoff NK, Fong MS, Teeraananchai S, Ananworanich J, Durier N. Adherence to antiretroviral therapy, stigma and behavioral risk factors in HIV-infected adolescents in Asia. AIDS Care 2018; 30:727-733. [PMID: 29336591 DOI: 10.1080/09540121.2018.1425363] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
We studied behavioral risks among HIV-infected and uninfected adolescents using an audio computer-assisted self-interview. A prospective cohort study was initiated between 2013 and 2014 in Malaysia, Thailand, and Vietnam. HIV-infected adolescents were matched to uninfected adolescents (4:1) by sex and age group (12-14 and 15-18 years). We enrolled 250 HIV-infected (48% male; median age 14.5 years; 93% perinatally infected) and 59 uninfected (51% male; median age 14.1 years) adolescents. At enrollment, HIV-infected adolescents were on antiretroviral therapy (ART) for a median (IQR) of 7.5 (4.7-10.2) years, and 14% had HIV-RNA >1000 copies/mL; 19% reported adherence <80%. Eighty-four (34%) HIV-infected and 26 (44%) uninfected adolescents reported having ever smoked cigarettes or drunk alcohol (p = 0.13); 10% of HIV-infected and 17% of uninfected adolescents reported having initiated sexual activity; 6 of the HIV-infected adolescents had HIV-RNA >1000 copies/mL. Risk behaviors were common among adolescents, with few differences between those with and without HIV.
Collapse
Affiliation(s)
- Wasana Prasitsuebsai
- a The HIV Netherlands Australia Thailand Research Collaboration (HIV-NAT) , The Thai Red Cross AIDS Research Centre , Bangkok , Thailand
| | | | - Pagakrong Lumbiganon
- c Faculty of Medicine , Srinagarind Hospital, Khon Kaen University , Khon Kaen , Thailand
| | | | | | | | | | | | | | | | - Sirinya Teeraananchai
- a The HIV Netherlands Australia Thailand Research Collaboration (HIV-NAT) , The Thai Red Cross AIDS Research Centre , Bangkok , Thailand
| | - Jintanat Ananworanich
- k US Military HIV Research Program , Walter Reed Army Institute of Research , Silver Spring , USA.,l Henry M. Jackson Foundation for the Advancement of Military Medicine , Bethesda , USA.,m SEARCH, The Thai Red Cross AIDS Research Centre , Bangkok , Thailand.,n University of Amsterdam , Amsterdam , the Netherlands
| | - Nicolas Durier
- b TREAT Asia/amfAR-The Foundation for AIDS Research , Bangkok , Thailand.,o Dreamlopments LTD , Bangkok , Thailand
| | | |
Collapse
|
4
|
Sudjaritruk T, Aurpibul L, Ly PS, Le TPK, Bunupuradah T, Hansudewechakul R, Lumbiganon P, Chokephaibulkit K, Yusoff NKN, Van Nguyen L, Razali KAM, Fong MS, Nallusamy RA, Kurniati N, Do VC, Boettiger DC, Sohn AH, Kariminia A. Incidence of Postsuppression Virologic Rebound in Perinatally HIV-Infected Asian Adolescents on Stable Combination Antiretroviral Therapy. J Adolesc Health 2017; 61:91-98. [PMID: 28343759 PMCID: PMC5483211 DOI: 10.1016/j.jadohealth.2017.01.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 12/28/2016] [Accepted: 01/29/2017] [Indexed: 01/30/2023]
Abstract
PURPOSE To assess the incidence and predictors of postsuppression virologic rebound (VR) among adolescents on stable combination antiretroviral therapy in Asia. METHODS Perinatally HIV-infected Asian adolescents (10-19 years) with documented virologic suppression (two consecutive viral loads [VLs] <400 copies/mL ≥6 months apart) were included. Baseline was the date of the first VL <400 copies/mL at age ≥10 years or the 10th birthday for those with prior suppression. Cox proportional hazards models were used to identify predictors of postsuppression VR (VL >1,000 copies/mL). RESULTS Of 1,379 eligible adolescents, 47% were males. At baseline, 22% were receiving protease inhibitor-containing regimens; median CD4 cell count (interquartile range [IQR]) was 685 (448-937) cells/mm3; 2% had preadolescent virologic failure (VF) before subsequent suppression. During adolescence, 180 individuals (13%) experienced postsuppression VR at a rate of 3.4 (95% confidence interval: 2.9-3.9) per 100 person-years, which was consistent over time. Median time to VR during adolescence (IQR) was 3.3 (2.1-4.8) years. Wasting (weight-for-age z-score <-2.5), being raised by grandparents, receiving second-line protease inhibitor-based regimens, starting combination antiretroviral therapy after 2005, and having preadolescent VF were independent predictors of adolescent VR. At VR, median age, CD4 cell count, and VL (IQR) were 14.8 (13.2-16.4) years, 507 (325-723) cells/mm3, and 4.1 (3.5-4.7) log10 copies/mL, respectively. CONCLUSIONS A modest and consistent incidence of postsuppression VR was documented during adolescence in our cohort. Having poor weight, receiving second-line regimens, and prior VF were associated with an increased VR rate. Adolescents at higher risk of VR may benefit from more intensive VL monitoring to enhance adherence management.
Collapse
Affiliation(s)
- Tavitiya Sudjaritruk
- Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand.
| | - Linda Aurpibul
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Penh Sun Ly
- National Centre for HIV/AIDS, Dermatology and STDs, Phnom Penh, Cambodia
| | | | | | | | - Pagakrong Lumbiganon
- Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Kulkanya Chokephaibulkit
- Department of Pediatrics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | | | | | | | | | - Nia Kurniati
- Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Viet Chau Do
- Children's Hospital 2, Ho Chi Minh City, Vietnam
| | | | - Annette H. Sohn
- TREAT Asia/amfAR – The Foundation for AIDS Research, Bangkok, Thailand
| | | |
Collapse
|
5
|
Huy BV, Teeraananchai S, Oanh LN, Tucker J, Kurniati N, Hansudewechakul R, Truong KH, Khol V, Nguyen LV, Chau Do V, Lumbiganon P, Kongstan N, Bunupuradah T, Sudjaritruk T, Kumarasamy N, Yusoff NKN, Mohd Razali KA, Wati DK, Fong MS, Nallusamy R, Kariminia A, Sohn AH. Impact of orphan status on HIV treatment outcomes and retention in care of children and adolescents in Asia. J Virus Erad 2016; 2:227-231. [PMID: 27781105 PMCID: PMC5075350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
An analysis of the impact of orphanhood at antiretroviral therapy (ART) initiation on HIV outcomes in Asia included 4300 children; 51% were male. At ART initiation, 1805 (42%) were non-orphans (median age: 3 years), 1437 (33%) were single orphans (6 years) and 1058 (25%) were double orphans (7 years). Ten-year post-ART survival was 93.4-95.2% across orphan categories. Clinic transfers were higher among single and double orphans than non-orphans (41% vs 11%, P<0.001). On multivariate analysis, children ≥3 years at ART initiation (hazard ratio 1.58 vs <3 years, 95% confidence interval: 1.11-2.24) were more likely to be lost to follow-up. Although post-ART mortality and retention did not differ by orphan status, orphans were at greater risk of starting ART at older ages, and with more severe immunosuppression and poorer growth.
Collapse
Affiliation(s)
- Bui Vu Huy
- Hanoi Medical University,
Hanoi,
Vietnam;
| | | | - Le Ngoc Oanh
- Worldwide Orphans Foundation,
Ho Chi Minh City,
Vietnam;
| | - John Tucker
- New Hope for Cambodian Children,
Phnom Penh,
Cambodia;
| | - Nia Kurniati
- Cipto Mangunkusumo – Faculty of Medicine Universitas Indonesia,
Jakarta,
Indonesia;
| | | | | | - Vohith Khol
- National Centre for HIV/AIDS Dermatology and STDs and University of Health Sciences,
Phnom Penh,
Cambodia;
| | | | - Viet Chau Do
- Children's Hospital 2,
Ho Chi Minh City,
Vietnam;
| | - Pagakrong Lumbiganon
- Department of Pediatrics, Faculty of Medicine,
Khon Kaen University,
Khon Kaen,
Thailand;
| | - Nantaka Kongstan
- Department of Pediatrics, Faculty of Medicine Siriraj Hospital,
Mahidol University,
Bangkok,
Thailand;
| | | | - Tavitiya Sudjaritruk
- Department of Pediatrics, Faculty of Medicine,
Chiang Mai University and Research Institute for Health Sciences,
Chiang Mai,
Thailand;
| | | | | | | | | | | | | | | | - Annette H Sohn
- TREAT Asia/amfAR – The Foundation for AIDS Research,
Bangkok,
Thailand.,Corresponding author: Annette H Sohn,
TREAT Asia/amfAR,
388 Sukhumvit Road, 2104 Klongtoey,
Bangkok10110,
Thailand
| |
Collapse
|
6
|
Boettiger DC, Muktiarti D, Kurniati N, Truong KH, Saghayam S, Ly PS, Hansudewechakul R, Van Nguyen L, Do VC, Sudjaritruk T, Lumbiganon P, Chokephaibulkit K, Bunupuradah T, Nik Yusoff NK, Wati DK, Mohd Razali KA, Fong MS, Nallusamy RA, Sohn AH, Kariminia A. Early Height and Weight Changes in Children Using Cotrimoxazole Prophylaxis With Antiretroviral Therapy. Clin Infect Dis 2016; 63:1236-1244. [PMID: 27470239 DOI: 10.1093/cid/ciw514] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 07/21/2016] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The growth benefits of cotrimoxazole during early antiretroviral therapy (ART) are not well characterized. METHODS Individuals enrolled in the Therapeutics Research, Education, and AIDS Training in Asia Pediatric HIV Observational Database were included if they started ART at ages 1 month-14 years and had both height and weight measurements available at ART initiation (baseline). Generalized estimating equations were used to identify factors associated with change in height-for-age z-score (HAZ), follow-up HAZ ≥ -2, change in weight-for-age z-score (WAZ), and follow-up WAZ ≥ -2. RESULTS A total of 3217 children were eligible for analysis. The adjusted mean change in HAZ among cotrimoxazole and non-cotrimoxazole users did not differ significantly over the first 24 months of ART. In children who were stunted (HAZ < -2) at baseline, cotrimoxazole use was not associated with a follow-up HAZ ≥ -2. The adjusted mean change in WAZ among children with a baseline CD4 percentage (CD4%) >25% became significantly different between cotrimoxazole and non-cotrimoxazole users after 6 months of ART and remained significant after 24 months (overall P < .01). Similar changes in WAZ were observed in those with a baseline CD4% between 10% and 24% (overall P < .01). Cotrimoxazole use was not associated with a significant difference in follow-up WAZ in children with a baseline CD4% <10%. In those underweight (WAZ < -2) at baseline, cotrimoxazole use was associated with a follow-up WAZ ≥ -2 (adjusted odds ratio, 1.70 vs not using cotrimoxazole [95% confidence interval, 1.28-2.25], P < .01). This association was driven by children with a baseline CD4% ≥10%. CONCLUSIONS Cotrimoxazole use is associated with benefits to WAZ but not HAZ during early ART in Asian children.
Collapse
Affiliation(s)
- David C Boettiger
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | | | - Nia Kurniati
- Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | | | - Suneeta Saghayam
- Y.R. Gaitonde Center for AIDS Research and Education Medical Centre, Chennai, India
| | - Penh Sun Ly
- National Centre for HIV/AIDS, Dermatology, and Sexually Transmitted Diseases, Phnom Penh, Cambodia
| | | | | | - Viet Chau Do
- Children's Hospital 2, Ho Chi Minh City, Vietnam
| | - Tavitiya Sudjaritruk
- Department of Pediatrics, Faculty of Medicine, Chiang Mai University and Research Institute for Health Sciences, Chiang Mai
| | | | | | - Torsak Bunupuradah
- HIV Netherlands Australia Thailand Research Collaboration, Thai Red Cross AIDS Research Centre, Bangkok, Thailand
| | | | | | | | | | | | - Annette H Sohn
- TREAT Asia/amfAR-Foundation for AIDS Research, Bangkok, Thailand
| | - Azar Kariminia
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | | |
Collapse
|
7
|
Sudjaritruk T, Maleesatharn A, Prasitsuebsai W, Fong SM, Le NO, Le TTT, Lumbiganon P, Kumarasamy N, Kurniati N, Hansudewechakul R, Yusoff NKN, Razali KAM, Kariminia A, Sohn AH, Sirisanthana, on behalf of the TREA V. Prevalence, characteristics, management, and outcome of pulmonary tuberculosis in HIV-infected children in the TREAT Asia pediatric HIV Observational Database (TApHOD). AIDS Patient Care STDS 2013; 27:649-56. [PMID: 24206012 DOI: 10.1089/apc.2013.0236] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
A multicenter, retrospective, observational study was conducted to determine prevalence, characteristics, management, and outcome of pulmonary tuberculosis (PTB) in Asian HIV-infected children in the TREAT Asia Pediatric HIV Observational Database (TApHOD). Data on PTB episodes diagnosed during the period between 12 months before antiretroviral therapy (ART) initiation and December 31, 2009 were extracted. A total of 2678 HIV-infected children were included in TApHOD over a 13-year period; 457 developed PTB, giving a period prevalence of 17.1% (range 5.7-33.0% per country). There were a total of 484 PTB episodes; 27 children had 2 episodes each. There were 21 deaths (4.3%). One third of episodes (n=175/484) occurred after ART initiation at a median of 14.1 months (interquartile range [IQR] 2.5-28.8 months). The median (IQR) CD4+ values were 9.0% (3.0-16.0%) and 183.5 (37.8-525.0) cells/mm(3) when PTB was diagnosed. Most episodes (n=424/436, 97.3%) had abnormal radiographic findings compatible with PTB, whereas half (n=267/484, 55.2%) presented with clinical characteristics of PTB. One third of those tested (n=42/122, 34.4%) had bacteriological evidence of PTB. Of the 156 episodes (32.2%) that were accompanied with extrapulmonary TB, pleuritis was the most common manifestation (81.4%). After treatment completion, most episodes (n=396/484, 81.9%) were recorded as having positive outcomes (cured, treatment completed and child well, and improvement). The prevalence of PTB among Asian HIV-infected children in our cohort was high. Children with persistent immunosuppression remain vulnerable to PTB even after ART initiation.
Collapse
Affiliation(s)
- Tavitiya Sudjaritruk
- Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
| | | | - Wasana Prasitsuebsai
- HIV-Netherlands, Australia, Thaliand HIV-NAT/Thai Red Cross AIDS Research Centre, Bangkok, Thailand
| | | | - Ngoc Oanh Le
- Worldwide Orphans Foundation, Ho Chi Minh City, Vietnam
| | | | | | | | - Nia Kurniati
- Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | | | | | | | - Azar Kariminia
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Annette H. Sohn
- TREAT Asia, amfAR—The Foundation for AIDS Research, Bangkok, Thailand
| | | | | |
Collapse
|
8
|
Lumbiganon P, Kariminia A, Aurpibul L, Hansudewechakul R, Puthanakit T, Kurniati N, Kumarasamy N, Chokephaibulkit K, Nik Yusoff NK, Vonthanak S, Moy FS, Razali KAM, Nallusamy R, Sohn AH. Survival of HIV-infected children: a cohort study from the Asia-Pacific region. J Acquir Immune Defic Syndr 2011; 56:365-71. [PMID: 21160429 PMCID: PMC3072816 DOI: 10.1097/qai.0b013e318207a55b] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Combination antiretroviral therapy (ART) has been used for HIV-infected children in many Asian countries since 2002. This study describes survival outcomes among HIV-infected children in a multicenter regional cohort in Asia. PATIENTS AND METHODS Retrospective and prospective data collected through March 2009 from children in 5 countries enrolled in TREAT Asia's Pediatric HIV Observational Database were analysed. Multivariate Cox proportional hazard models were used to assess factors associated with mortality in children who received ART. RESULTS Among 2280 children, 1752 (77%) had received ART. During a median follow-up of 3.1 years after ART, 115 (6.6%) deaths occurred, giving a crude mortality rate of 1.9 per 100 child-years [95% confidence interval (CI): 1.6 to 2.4]. The mortality rate was highest in the first 3 months of ART (10.2 per 100 child-years; 95% CI: 7.5 to 13.7) and declined after 12 months (0.9 per 100 child-years; 95% CI: 0.7 to 1.3). Those with a low recent CD4 percentage, who started ART with lower baseline weight-for-age Z score, or with WHO clinical stage 4 had an increased risk of death. Of 528 (23%) children who never received ART, 36 (6.8%) died after presenting to care, giving a crude mortality rate of 4.1 per 100 child-years (95% CI: 3.0 to 5.7), with a lost-to-program rate of 31.5 per 100 child-years (95% CI: 28.0 to 35.5). CONCLUSIONS The high mortality during the first 3 months of ART and in those with low CD4 percentage support the implementation of early diagnosis and ART initiation.
Collapse
|