| Mortality and Clinical Outcomes in HIV-Infected Children on Antiretroviral Therapy in Malawi, Lesotho, and Swaziland. | |
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MedLine Citation:
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PMID: 22891234 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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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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Authors:
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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:
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Type: JOURNAL ARTICLE Date: 2012-8-13 |
Journal Detail:
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Title: Pediatrics Volume: - ISSN: 1098-4275 ISO Abbreviation: Pediatrics Publication Date: 2012 Aug |
Date Detail:
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Created Date: 2012-8-14 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0376422 Medline TA: Pediatrics Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Affiliation:
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Baylor College of Medicine Abbott Fund Children's Clinical Centre of Excellence, Lilongwe, Malawi; |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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