Document Detail


The Effect of Early Initiation of Antiretroviral Treatment in Infants Receiving Pediatric Auto Immune Deficiency Syndrome Mortality in South Africa: A Model-Based Analysis.
MedLine Citation:
PMID:  22189534     Owner:  NLM     Status:  Publisher    
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 mathematic 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% 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 towards 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-Anne Davies; Harry Moultrie; Gayle G Sherman; Ruth M Bland; Thomas M Rehle; Rob E Dorrington; Marie-Louise Newell
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-12-20
Journal Detail:
Title:  The Pediatric infectious disease journal     Volume:  -     ISSN:  1532-0987     ISO Abbreviation:  -     Publication Date:  2011 Dec 
Date Detail:
Created Date:  2011-12-22     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8701858     Medline TA:  Pediatr Infect Dis J     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
1.Centre for Infectious Disease Epidemiology and Research, University of Cape Town 2.Harriet Shezi Children's Clinic, Chris Hani Baragwanath Hospital 3.Wits Reproductive Health and HIV Institute, University of Witwatersrand 4.Department of Molecular Medicine and Haemotology, Faculty of Health Sciences, University of the Witwatersrand and National Health Laboratory Service 5.Africa Centre for Health and Population Studies, University of KwaZulu-Natal 6.Division of Developmental Medicine, University of Glasgow 7.Human Sciences Research Council, South Africa 8.Centre for Actuarial Research, University of Cape Town 9.Centre for Paediatric Epidemiology and Biostatistics, Institute of Child Health, University College, London.
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