Document Detail


Mortality and clinical outcomes in HIV-infected children on antiretroviral therapy in Malawi, Lesotho, and Swaziland.
MedLine Citation:
PMID:  22891234     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
Mark M Kabue; W Chris Buck; Sebastian R Wanless; Carrie M Cox; Eric D McCollum; A Chantal Caviness; Saeed Ahmed; Maria H Kim; Lineo Thahane; Andrew Devlin; Duncan Kochelani; Peter N Kazembe; Nancy R Calles; Michael B Mizwa; Gordon E Schutze; Mark W Kline
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2012-08-13
Journal Detail:
Title:  Pediatrics     Volume:  130     ISSN:  1098-4275     ISO Abbreviation:  Pediatrics     Publication Date:  2012 Sep 
Date Detail:
Created Date:  2012-09-03     Completed Date:  2012-11-09     Revised Date:  2014-04-13    
Medline Journal Info:
Nlm Unique ID:  0376422     Medline TA:  Pediatrics     Country:  United States    
Other Details:
Languages:  eng     Pagination:  e591-9     Citation Subset:  AIM; IM    
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MeSH Terms
Descriptor/Qualifier:
Anti-Retroviral Agents / therapeutic use*
CD4 Lymphocyte Count
Child
Child, Preschool
Female
HIV Infections / drug therapy*,  immunology,  mortality*
Humans
Infant
Lesotho / epidemiology
Malawi / epidemiology
Male
Nutritional Status
Swaziland / epidemiology
Grant Support
ID/Acronym/Agency:
D43 TW01036/TW/FIC NIH HHS; T32 HL072748/HL/NHLBI NIH HHS
Chemical
Reg. No./Substance:
0/Anti-Retroviral Agents
Comments/Corrections

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