Document Detail


Outcomes of antiretroviral therapy in children in Asia and Africa: a comparative analysis of the IeDEA pediatric multiregional collaboration.
MedLine Citation:
PMID:  23187940     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: We investigated 18-month incidence and determinants of death and loss to follow-up of children after antiretroviral therapy (ART) initiation in a multiregional collaboration in lower-income countries.
METHODS: HIV-infected children (positive polymerase chain reaction <18 months or positive serology ≥18 months) from International Epidemiologic Databases to Evaluate AIDS cohorts, <16 years, initiating ART were eligible. A competing risk regression model was used to analyze the independent risk of 2 failure types: death and loss to follow-up (>6 months).
FINDINGS: Data on 13,611 children, from Asia (N = 1454), East Africa (N = 3114), Southern Africa (N = 6212), and West Africa (N = 2881) contributed 20,417 person-years of follow-up. At 18 months, the adjusted risk of death was 4.3% in East Africa, 5.4% in Asia, 5.7% in Southern Africa, and 7.4% in West Africa (P = 0.01). Age < 24 months, World Health Organization stage 4, CD4 < 10%, attending a private sector clinic, larger cohort size, and living in West Africa were independently associated with poorer survival. The adjusted risk of loss to follow-up was 4.1% in Asia, 9.0% in Southern Africa, 14.0% in East Africa, and 21.8% in West Africa (P < 0.01). Age < 12 months, nonnucleoside reverse transcriptase inhibitor I-based ART regimen, World Health Organization stage 4 at ART start, ART initiation after 2005, attending a public sector or a nonurban clinic, having to pay for laboratory tests or antiretroviral drugs, larger cohort size, and living in East Africa or West Africa were significantly associated with higher loss to follow-up.
CONCLUSIONS: Findings differed substantially across regions but raise overall concerns about delayed ART start, low access to free HIV services for children, and increased workload on program retention in lower-income countries. Universal free access to ART services and innovative approaches are urgently needed to improve pediatric outcomes at the program level.
Authors:
Valeriane Leroy; Karen Malateste; Helena Rabie; Pagakrong Lumbiganon; Samuel Ayaya; Fatoumata Dicko; Mary-Ann Davies; Azar Kariminia; Kara Wools-Kaloustian; Edmond Aka; Samuel Phiri; Linda Aurpibul; Constantin Yiannoutsos; Haby Signaté-Sy; Lynne Mofenson; François Dabis;
Publication Detail:
Type:  Comparative Study; Journal Article; Multicenter Study; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  Journal of acquired immune deficiency syndromes (1999)     Volume:  62     ISSN:  1944-7884     ISO Abbreviation:  J. Acquir. Immune Defic. Syndr.     Publication Date:  2013 Feb 
Date Detail:
Created Date:  2013-01-18     Completed Date:  2013-03-08     Revised Date:  2014-02-04    
Medline Journal Info:
Nlm Unique ID:  100892005     Medline TA:  J Acquir Immune Defic Syndr     Country:  United States    
Other Details:
Languages:  eng     Pagination:  208-19     Citation Subset:  IM; X    
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Africa, Eastern / epidemiology
Africa, Southern / epidemiology
Africa, Western / epidemiology
Age Factors
Anti-Retroviral Agents / economics,  therapeutic use*
Asia / epidemiology
CD4 Lymphocyte Count
Child
Child, Preschool
Cohort Studies
Developing Countries*
Female
HIV Infections / drug therapy*,  immunology,  mortality*
HIV Protease Inhibitors / therapeutic use
Humans
Infant
International Cooperation
Lost to Follow-Up*
Male
Reverse Transcriptase Inhibitors / therapeutic use
Severity of Illness Index
Statistics, Nonparametric
Grant Support
ID/Acronym/Agency:
5U01AI069919-01/AI/NIAID NIH HHS; 5U01AI069919-02/AI/NIAID NIH HHS; 5U01AI069919-03/AI/NIAID NIH HHS; 5U01AI069919-04/AI/NIAID NIH HHS; U01 AI069907/AI/NIAID NIH HHS; U01 AI069911/AI/NIAID NIH HHS; U01 AI069919/AI/NIAID NIH HHS; U01 AI069924/AI/NIAID NIH HHS
Chemical
Reg. No./Substance:
0/Anti-Retroviral Agents; 0/HIV Protease Inhibitors; 0/Reverse Transcriptase Inhibitors
Comments/Corrections
Comment In:
J Acquir Immune Defic Syndr. 2013 Feb 1;62(2):127-8   [PMID:  23018370 ]

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