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Lubega J, Kim TO, Airewele G, Grimes A, Bulsara S, Peckham E, Wanless SR, Haq H, Elyanu P, Musoke P, Lumumba M, Kekitiinwa A, Matshaba M, Scheurer M, Despotovic J. Risk factors and prognostic significance of platelet count abnormalities in children with HIV infection on antiretroviral therapy. AIDS 2023; 37:413-421. [PMID: 36129118 PMCID: PMC9877116 DOI: 10.1097/qad.0000000000003387] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVES To establish the incidence, risk factors and correlation with survival of thrombocytopenia and thrombocytosis (T/T) among children with HIV infection (CWH). DESIGN A retrospective nested case control study of patients 0-18 years in five Baylor International Pediatric AIDS Initiative (BIPAI) centers in sub-Sahara Africa, 2004-2014. METHODS Clinical and laboratory variables including complete blood counts (CBC) were extracted from the BIPAI electronic medical record system. Incident cases of T/T were identified and frequency-matched on follow-up time with controls with normal platelets. We calculated the prevalence and incidence density of T/T and used conditional logistic regression to evaluate their association with selected clinical variables. We constructed Kaplan-Meier curves and a Cox proportional hazards model to evaluate the impact of T/T on survival. RESULTS Two thousand, one hundred and nine children were sampled. The incidence density of thrombocytopenia was 1 per 57.9 (95% confidence interval [CI] 50.3-66.8) CWH-years. Thrombocytopenia was higher in children with WHO Stage III/IV, lower in children on zidovudine, and had no association with use of lamivudine or nevirapine, CD4 + suppression, age, and nutrition status. Thrombocytopenia was independently associated with 2.2-fold higher mortality (95% CI 1.62-3.08). The incidence density of thrombocytosis was 1 per 11.4 (95% CI 10.7-12.1) CWH-years. Thrombocytosis was associated with higher CD4 + cell count, younger age, and use of lamivudine or nevirapine, and did not impact survival. CONCLUSIONS Platelet count is a clinically valuable biomarker of HIV clinical progression and mortality. Laboratory studies are necessary to elucidate the mechanisms of T/T.
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Affiliation(s)
- Joseph Lubega
- Baylor College of Medicine, Houston, Texas, 77030, United States
| | - Taylor O Kim
- Baylor College of Medicine, Houston, Texas, 77030, United States
| | | | - Amanda Grimes
- Baylor College of Medicine, Houston, Texas, 77030, United States
| | - Shaun Bulsara
- Baylor College of Medicine, Houston, Texas, 77030, United States
| | - Erin Peckham
- Baylor College of Medicine, Houston, Texas, 77030, United States
| | | | - Heather Haq
- Baylor College of Medicine, Houston, Texas, 77030, United States
| | | | | | | | | | | | - Michael Scheurer
- Baylor College of Medicine, Houston, Texas, 77030, United States
| | - Jenny Despotovic
- Baylor College of Medicine, Houston, Texas, 77030, United States
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Lubega J, Grimes A, Airewele G, Bulsara S, Kim TO, Haq H, Peckham-Gregory E, Wanless SR, Elyanu P, Musoke P, Lumumba M, Kekitiinwa A, Matshaba M, Despotovic J, Scheurer M. Risk factors and prognostic significance of anemia in children with HIV infection on antiretroviral therapy. AIDS 2022; 36:2139-2146. [PMID: 36052537 PMCID: PMC9671853 DOI: 10.1097/qad.0000000000003374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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
OBJECTIVES To establish the incidence, risk factors and prognostic effect of anemia in children living with HIV (CLWH). DESIGN Retrospective nested case-control study of patients 0-18 years in five centers in sub-Saharan Africa, 2004-2014. METHODS Incident cases of anemia were identified from electronic records and matched with CLWH without anemia. We calculated the incidence density of anemia and used conditional logistic regression to evaluate its association with risk factors, stratified by severity and type of anemia. We used a Cox proportional hazards model to evaluate the impact of anemia on survival. RESULTS Two thousand, one hundred and thirty-seven children were sampled. The incidence density of anemia was 1 per 6.6 CLWH-years. Anemia was moderate in 31.8% and severe in 17.3% of anemia cases, which had 10-year mortality hazards of 3.4 and 4.5, respectively. Microcytic anemia (36% cases) was associated with 2.3-fold hazard of 10-year mortality, and with malnutrition and CD4 + suppression. Normocytic anemia (50.5% cases) was associated with 2.6-fold hazards of 10-year mortality, and with more severe malnutrition, CD4 + suppression, and WHO stage, but inversely associated with lamivudine and nevirapine therapy. Macrocytic anemia (13.5% cases) was neither associated with higher 10-year mortality nor with severe malnutrition or CD4 + suppression but was associated with WHO stage II/III and negatively associated with lamivudine therapy. CONCLUSION This large multicountry study of CLWH found a high incidence density of anemia. Higher severity, normocytic and microcytic types of anemia were independently associated with long-term mortality. Laboratory studies are needed to decipher the mechanisms of anemia and how it impacts mortality in CLWH.
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Haq H, Elyanu P, Bulsara S, Bacha JM, Campbell LR, El-Mallawany NK, Keating EM, Kisitu GP, Mehta PS, Rees CA, Slone JS, Kekitiinwa AR, Matshaba M, Mizwa MB, Mwita L, Schutze GE, Wanless SR, Scheurer ME, Lubega J. Association between Antiretroviral Therapy and Cancers among Children Living with HIV in Sub-Saharan Africa. Cancers (Basel) 2021; 13:cancers13061379. [PMID: 33803641 PMCID: PMC8003101 DOI: 10.3390/cancers13061379] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 03/02/2021] [Accepted: 03/14/2021] [Indexed: 02/06/2023] Open
Abstract
Simple Summary Most children infected with HIV live in Sub-Sahara Africa (SSA). These children are at risk of cancers related to HIV infection, but the degree of this risk and how it is influenced by antiretroviral therapy (ART) is unknown. In this study, we determined the subtypes, incidence, and risk factors of cancers in children with HIV in SSA and receiving ART with the goal of learning how we may prevent these cancers. We found that Kaposi sarcoma and lymphoma are the most common, comprising about 77% and 19% of cancers in these children, respectively. For every 100,000 person-years, 47.6 children developed cancer. Waiting to start ART until after 2 years old and having had severe immunosuppression were the two biggest risk factors for cancer that we identified. The findings justify the recommendations to start children on ART as soon as they are diagnosed with HIV regardless of their CD4 immune status. Abstract Approximately 91% of the world’s children living with HIV (CLWH) are in sub-Saharan Africa (SSA). Living with HIV confers a risk of developing HIV-associated cancers. To determine the incidence and risk factors for cancer among CLWH, we conducted a nested case-control study of children 0–18 years from 2004–2014 at five centers in four SSA countries. Incident cases of cancer and HIV were frequency-matched to controls with HIV and no cancer. We calculated the incidence density by cancer type, logistic regression, and relative risk to evaluate risk factors of cancer. The adjusted incidence density of all cancers, Kaposi sarcoma, and lymphoma were 47.6, 36.6, and 8.94 per 100,000 person-years, respectively. Delayed ART until after 2 years of age was associated with cancer (OR = 2.71, 95% CI 1.51, 4.89) even after adjusting for World Health Organization clinical stage at the time of enrolment for HIV care (OR = 2.85, 95% CI 1.57, 5.13). The relative risk of cancer associated with severe CD4 suppression was 6.19 (p = 0.0002), 2.33 (p = 0.0042), and 1.77 (p = 0.0305) at 1, 5, and 10 years of ART, respectively. The study demonstrates the high risk of cancers in CLWH and the potential benefit of reducing this risk by the early initiation of ART.
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Affiliation(s)
- Heather Haq
- Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA; (H.H.); (S.B.); (J.M.B.); (L.R.C.); (N.K.E.-M.); (E.M.K.); (P.S.M.); (C.A.R.); (J.S.S.); (M.B.M.); (G.E.S.); (M.E.S.)
- Baylor College of Medicine International Pediatric AIDS Initiative (BIPAI) at Texas Children’s Hospital, Houston, TX 77030, USA;
| | - Peter Elyanu
- Baylor College of Medicine Children’s Foundation-Uganda, Kampala, Uganda; (P.E.); (G.P.K.); (A.R.K.)
| | - Shaun Bulsara
- Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA; (H.H.); (S.B.); (J.M.B.); (L.R.C.); (N.K.E.-M.); (E.M.K.); (P.S.M.); (C.A.R.); (J.S.S.); (M.B.M.); (G.E.S.); (M.E.S.)
| | - Jason M. Bacha
- Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA; (H.H.); (S.B.); (J.M.B.); (L.R.C.); (N.K.E.-M.); (E.M.K.); (P.S.M.); (C.A.R.); (J.S.S.); (M.B.M.); (G.E.S.); (M.E.S.)
- Baylor College of Medicine International Pediatric AIDS Initiative (BIPAI) at Texas Children’s Hospital, Houston, TX 77030, USA;
- Baylor College of Medicine Children’s Foundation-Tanzania, Mbeya, Tanzania;
| | - Liane R. Campbell
- Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA; (H.H.); (S.B.); (J.M.B.); (L.R.C.); (N.K.E.-M.); (E.M.K.); (P.S.M.); (C.A.R.); (J.S.S.); (M.B.M.); (G.E.S.); (M.E.S.)
- Baylor College of Medicine International Pediatric AIDS Initiative (BIPAI) at Texas Children’s Hospital, Houston, TX 77030, USA;
- Baylor College of Medicine Children’s Foundation-Tanzania, Mbeya, Tanzania;
| | - Nader K. El-Mallawany
- Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA; (H.H.); (S.B.); (J.M.B.); (L.R.C.); (N.K.E.-M.); (E.M.K.); (P.S.M.); (C.A.R.); (J.S.S.); (M.B.M.); (G.E.S.); (M.E.S.)
| | - Elizabeth M. Keating
- Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA; (H.H.); (S.B.); (J.M.B.); (L.R.C.); (N.K.E.-M.); (E.M.K.); (P.S.M.); (C.A.R.); (J.S.S.); (M.B.M.); (G.E.S.); (M.E.S.)
- Baylor College of Medicine Children’s Foundation-Lesotho, Maseru, Lesotho
| | - Grace P. Kisitu
- Baylor College of Medicine Children’s Foundation-Uganda, Kampala, Uganda; (P.E.); (G.P.K.); (A.R.K.)
| | - Parth S. Mehta
- Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA; (H.H.); (S.B.); (J.M.B.); (L.R.C.); (N.K.E.-M.); (E.M.K.); (P.S.M.); (C.A.R.); (J.S.S.); (M.B.M.); (G.E.S.); (M.E.S.)
- Global Hematology Oncology Pediatric Excellence Program, Texas Children’s Cancer and Hematology Centers, Houston, TX 77030, USA
| | - Chris A. Rees
- Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA; (H.H.); (S.B.); (J.M.B.); (L.R.C.); (N.K.E.-M.); (E.M.K.); (P.S.M.); (C.A.R.); (J.S.S.); (M.B.M.); (G.E.S.); (M.E.S.)
- Baylor College of Medicine Children’s Foundation-Malawi, Lilongwe, Malawi
| | - Jeremy S. Slone
- Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA; (H.H.); (S.B.); (J.M.B.); (L.R.C.); (N.K.E.-M.); (E.M.K.); (P.S.M.); (C.A.R.); (J.S.S.); (M.B.M.); (G.E.S.); (M.E.S.)
- Global Hematology Oncology Pediatric Excellence Program, Texas Children’s Cancer and Hematology Centers, Houston, TX 77030, USA
| | - Adeodata R. Kekitiinwa
- Baylor College of Medicine Children’s Foundation-Uganda, Kampala, Uganda; (P.E.); (G.P.K.); (A.R.K.)
| | - Mogomotsi Matshaba
- Botswana-Baylor Children’s Clinical Centre of Excellence, Gabarone, Botswana;
| | - Michael B. Mizwa
- Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA; (H.H.); (S.B.); (J.M.B.); (L.R.C.); (N.K.E.-M.); (E.M.K.); (P.S.M.); (C.A.R.); (J.S.S.); (M.B.M.); (G.E.S.); (M.E.S.)
- Baylor College of Medicine International Pediatric AIDS Initiative (BIPAI) at Texas Children’s Hospital, Houston, TX 77030, USA;
| | - Lumumba Mwita
- Baylor College of Medicine Children’s Foundation-Tanzania, Mbeya, Tanzania;
| | - Gordon E. Schutze
- Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA; (H.H.); (S.B.); (J.M.B.); (L.R.C.); (N.K.E.-M.); (E.M.K.); (P.S.M.); (C.A.R.); (J.S.S.); (M.B.M.); (G.E.S.); (M.E.S.)
- Baylor College of Medicine International Pediatric AIDS Initiative (BIPAI) at Texas Children’s Hospital, Houston, TX 77030, USA;
| | - Sebastian R. Wanless
- Baylor College of Medicine International Pediatric AIDS Initiative (BIPAI) at Texas Children’s Hospital, Houston, TX 77030, USA;
| | - Michael E. Scheurer
- Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA; (H.H.); (S.B.); (J.M.B.); (L.R.C.); (N.K.E.-M.); (E.M.K.); (P.S.M.); (C.A.R.); (J.S.S.); (M.B.M.); (G.E.S.); (M.E.S.)
| | - Joseph Lubega
- Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA; (H.H.); (S.B.); (J.M.B.); (L.R.C.); (N.K.E.-M.); (E.M.K.); (P.S.M.); (C.A.R.); (J.S.S.); (M.B.M.); (G.E.S.); (M.E.S.)
- Global Hematology Oncology Pediatric Excellence Program, Texas Children’s Cancer and Hematology Centers, Houston, TX 77030, USA
- Correspondence: ; Tel.: +1-8328224242
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Kabue MM, Buck WC, Wanless SR, Cox CM, McCollum ED, Caviness AC, Ahmed S, Kim MH, Thahane L, Devlin A, Kochelani D, Kazembe PN, Calles NR, Mizwa MB, Schutze GE, Kline MW. Mortality and clinical outcomes in HIV-infected children on antiretroviral therapy in Malawi, Lesotho, and Swaziland. Pediatrics 2012; 130:e591-9. [PMID: 22891234 PMCID: PMC3962849 DOI: 10.1542/peds.2011-1187] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [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] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To determine mortality and immune status improvement in HIV-infected pediatric patients on antiretroviral treatment (ART) in Malawi, Lesotho, and Swaziland. METHODS We conducted a retrospective cohort study of patients aged <12 years at ART initiation at 3 sites in sub-Saharan Africa between 2004 and 2009. Twelve-month and overall mortality were estimated, and factors associated with mortality and immune status improvement were evaluated. RESULTS Included in the study were 2306 patients with an average follow-up time on ART of 2.3 years (interquartile range 1.5-3.1 years). One hundred four patients (4.5%) died, 9.0% were lost to follow-up, and 1.3% discontinued ART. Of the 104 deaths, 77.9% occurred in the first year of treatment with a 12-month mortality rate of 3.5%. The overall mortality rate was 2.25 deaths/100 person-years (95% confidence interval [CI] 1.84-2.71). Increased 12-month mortality was associated with younger age; <6 months (hazard ratio [HR] = 8.11, CI 4.51-14.58), 6 to <12 months (HR = 3.43, CI 1.96-6.02), and 12 to <36 months (HR = 1.92, CI 1.16-3.19), and World Health Organization stage IV (HR = 4.35, CI 2.19-8.67). Immune status improvement at 12 months was less likely in patients with advanced disease and age <12 months. CONCLUSIONS Despite challenges associated with pediatric ART in developing countries, low mortality and good treatment outcomes can be achieved. However, outcomes are worse in younger patients and those with advanced disease at the time of ART initiation, highlighting the importance of early diagnosis and treatment.
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Affiliation(s)
- Mark M. Kabue
- Baylor College of Medicine Abbott Fund Children’s Clinical Centre of Excellence, Lilongwe, Malawi
| | - W. Chris Buck
- Baylor College of Medicine Abbott Fund Children’s Clinical Centre of Excellence, Lilongwe, Malawi;,Baylor College of Medicine International Pediatric AIDS Initiative at Texas Children’s Hospital, and
| | - Sebastian R. Wanless
- Baylor College of Medicine International Pediatric AIDS Initiative at Texas Children’s Hospital, and
| | - Carrie M. Cox
- Baylor College of Medicine Abbott Fund Children’s Clinical Centre of Excellence, Lilongwe, Malawi;,Baylor College of Medicine International Pediatric AIDS Initiative at Texas Children’s Hospital, and
| | - Eric D. McCollum
- Baylor College of Medicine Abbott Fund Children’s Clinical Centre of Excellence, Lilongwe, Malawi;,Baylor College of Medicine International Pediatric AIDS Initiative at Texas Children’s Hospital, and
| | - A. Chantal Caviness
- Baylor College of Medicine, Department of Pediatrics and Texas Children’s Hospital, Houston, Texas
| | - Saeed Ahmed
- Baylor College of Medicine Abbott Fund Children’s Clinical Centre of Excellence, Lilongwe, Malawi;,Baylor College of Medicine International Pediatric AIDS Initiative at Texas Children’s Hospital, and
| | - Maria H. Kim
- Baylor College of Medicine Abbott Fund Children’s Clinical Centre of Excellence, Lilongwe, Malawi;,Baylor College of Medicine International Pediatric AIDS Initiative at Texas Children’s Hospital, and
| | - Lineo Thahane
- Baylor College of Medicine Bristol-Myers Squibb Children’s Clinical Centre of Excellence, Maseru, Lesotho; and
| | - Andrew Devlin
- Baylor College of Medicine Bristol-Myers Squibb Children’s Clinical Centre of Excellence, Maseru, Lesotho; and
| | - Duncan Kochelani
- Baylor College of Medicine Bristol-Myers Squibb Children’s Clinical Centre of Excellence, Mbabane, Swaziland
| | - Peter N. Kazembe
- Baylor College of Medicine Abbott Fund Children’s Clinical Centre of Excellence, Lilongwe, Malawi
| | - Nancy R. Calles
- Baylor College of Medicine International Pediatric AIDS Initiative at Texas Children’s Hospital, and,Baylor College of Medicine, Department of Pediatrics and Texas Children’s Hospital, Houston, Texas
| | - Michael B. Mizwa
- Baylor College of Medicine International Pediatric AIDS Initiative at Texas Children’s Hospital, and
| | - Gordon E. Schutze
- Baylor College of Medicine International Pediatric AIDS Initiative at Texas Children’s Hospital, and,Baylor College of Medicine, Department of Pediatrics and Texas Children’s Hospital, Houston, Texas
| | - Mark W. Kline
- Baylor College of Medicine International Pediatric AIDS Initiative at Texas Children’s Hospital, and,Baylor College of Medicine, Department of Pediatrics and Texas Children’s Hospital, Houston, Texas
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