Document Detail


The effect of early initiation of antiretroviral treatment in infants on pediatric AIDS mortality in South Africa: a model-based analysis.
MedLine Citation:
PMID:  22189531     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Guidelines for treatment of pediatric HIV have recently changed to recommend that all infants who are identified as HIV-infected should start antiretroviral treatment (ART) immediately, regardless of their immunologic or clinical status. This study aims to assess the likely impact of this change in guideline in South Africa.
METHODS: A mathematical model was developed to simulate mother-to-child transmission of HIV, disease progression, and death of HIV-infected children <15 years of age. The model is calibrated to South African data sources, including prevention of mother-to-child transmission program coverage data, pre-ART survival data, ART program statistics, and pediatric HIV prevalence studies.
RESULTS: Relative to what would be expected in the absence of early ART initiation, the number of infant AIDS deaths over the 2010-2025 period is expected to drop by 23.6% (95% confidence interval [CI]: 22.5-24.5%) at current levels of polymerase chain reaction (PCR) diagnosis, and by 34.2% (95% CI: 32.7-35.6%) if PCR diagnosis increases to 80% of perinatally infected infants at 2 months. However, the pediatric HIV disease burden has shifted toward older children in recent years. The effect of early ART on total pediatric AIDS mortality during the 2010-2025 period is therefore modest: a 9.8% reduction (95% CI: 7.9-12.6%) at current levels of PCR diagnosis, and a 14.2% reduction (95% CI: 11.4-18.2%) if PCR coverage increases to 80% of perinatally infected infants.
CONCLUSION: The changes in ART guidelines for infants will have a significant impact on pediatric AIDS mortality at young ages, but further efforts are required to reduce the substantial growing AIDS mortality in older children.
Authors:
Leigh F Johnson; Mary-Ann Davies; Harry Moultrie; Gayle G Sherman; Ruth M Bland; Thomas M Rehle; Rob E Dorrington; Marie-Louise Newell
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The Pediatric infectious disease journal     Volume:  31     ISSN:  1532-0987     ISO Abbreviation:  Pediatr. Infect. Dis. J.     Publication Date:  2012 May 
Date Detail:
Created Date:  2012-04-18     Completed Date:  2012-08-06     Revised Date:  2014-02-24    
Medline Journal Info:
Nlm Unique ID:  8701858     Medline TA:  Pediatr Infect Dis J     Country:  United States    
Other Details:
Languages:  eng     Pagination:  474-80     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Anti-HIV Agents / administration & dosage*,  therapeutic use
Child
Child, Preschool
Disease Progression
HIV Infections / drug therapy*,  epidemiology,  mortality*,  transmission
HIV-1 / genetics
Humans
Infant
Infectious Disease Transmission, Vertical / prevention & control*
Models, Biological*
Polymerase Chain Reaction
Practice Guidelines as Topic
Prevalence
South Africa / epidemiology
Survival Analysis
Time Factors
Grant Support
ID/Acronym/Agency:
097410//Wellcome Trust; //Wellcome Trust
Chemical
Reg. No./Substance:
0/Anti-HIV Agents

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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