Cohort Profile: The TREAT Asia Pediatric HIV Observational Database

Kariminia, Azar; Chokephaibulkit, Kulkanya; Pang, Joselyn; Lumbiganon, Pagakrong; Hansudewechakul, Rawiwan; Amin, Janaki; Kumarasamy, Nagalingeswaran; Puthanakit, Thanyawee; Kurniati, Nia; Yusoff, Nik Khairulddin Nik; Saphonn, Vonthanak; Fong, Siew Moy; Razali, Kamarul Azahar Mohd; Nallusamy, Revathy; Sohn, Annette H.; Sirisanthana, Virat

doi:10.1093/ije/dyp358

Cited by 50 publications

(46 citation statements)

References 15 publications

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“…11, 13-15 The four African regions of IeDEA have been described in detail elsewhere. 11 In this study, we included five South African treatment programs that provide care for HIV-positive children: the Khayelitsha Township ART program, the Tygerberg Hospital program and the Red Cross War Memorial Children's Hospital program in Cape Town; and the Harriet Shezi and Rahima Moosa programs in Johannesburg.…”

Section: Methodsmentioning

confidence: 99%

Incidence of AIDS-defining and Other Cancers in HIV-positive Children in South Africa

Bohlius

Maxwell

Spoerri

et al. 2016

The Pediatric Infectious Disease Journal

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Background Little is known on the risk of cancer in HIV-positive children in sub-Saharan Africa. We examined incidence and risk factors of AIDS-defining and other cancers in pediatric antiretroviral therapy (ART) programs in South Africa. Methods We linked the records of five ART programs in Johannesburg and Cape Town to those of pediatric oncology units, based on name and surname, date of birth, folder and civil identification numbers. We calculated incidence rates and obtained hazard ratios (HR) with 95% confidence intervals (CI) from Cox regression models including ART, sex, age, and degree of immunodeficiency. Missing CD4 counts and CD4% were multiply imputed. Immunodeficiency was defined according to World Health Organization 2005 criteria. Results Data of 11,707 HIV-positive children were included in the analysis. During 29,348 person-years of follow-up 24 cancers were diagnosed, for an incidence rate of 82 per 100,000 person-years (95% CI 55-122). The most frequent cancers were Kaposi Sarcoma (34 per 100,000 person-years) and Non Hodgkin Lymphoma (31 per 100,000 person-years). The incidence of non AIDS-defining malignancies was 17 per 100,000. The risk of developing cancer was lower on ART (HR 0.29, 95%CI 0.09–0.86), and increased with age at enrolment (>10 versus <3 years: HR 7.3, 95% CI 2.2-24.6) and immunodeficiency at enrolment (advanced/severe versus no/mild: HR 3.5, 95%CI 1.1-12.0). The HR for the effect of ART from complete case analysis was similar but ceased to be statistically significant (p=0.078). Conclusions Early HIV diagnosis and linkage to care, with start of ART before advanced immunodeficiency develops, may substantially reduce the burden of cancer in HIV-positive children in South Africa and elsewhere.

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Section: Methodsmentioning

confidence: 99%

Incidence of AIDS-defining and Other Cancers in HIV-positive Children in South Africa

Bohlius

Maxwell

Spoerri

et al. 2016

The Pediatric Infectious Disease Journal

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“…This cohort contributes to the International Epidemiologic Databases to Evaluate AIDS global consortium and has been described previously. 12 Recruitment started in 2008. Up to March 2014, TApHOD included data from 5511 children that had ever received care from one of 16 pediatric clinics in Cambodia (n=1), India (n=1), Indonesia (n=2), Malaysia (n=4), Thailand (n=5), or Vietnam (n=3).…”

Section: Methodsmentioning

confidence: 99%

Antiretroviral Therapy in Severely Malnourished, HIV-infected Children in Asia

Boettiger

Aurpibul

Hudaya

et al. 2016

Pediatric Infectious Disease Journal

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Background Information on antiretroviral therapy (ART) use in HIV-infected children with severe malnutrition (SM) is lacking. We investigated long-term ART outcomes in this population. Methods Children enrolled in the TREAT Asia Pediatric HIV Observational Database who had SM (weight-for-height or BMI-for-age z-score <−3) at ART initiation were analyzed. Generalized estimating equations were used to investigate poor weight recovery (weight-for-age z-score <−3) and poor CD4% recovery (CD4% <25), and competing risk regression was used to analyze mortality and toxicity-associated treatment modification. Results Three hundred fifty five (11.9%) of 2993 children starting ART had SM. Their median weight-for-age z-score increased from −5.6 at ART initiation to −2.3 after 36 months. Not using cotrimoxazole prophylaxis at baseline was associated with poor weight recovery (OR 2.49 vs. using, 95%CI 1.66-3.74, p<0.001). Median CD4% increased from 3.0 at ART initiation to 27.2 after 36 months, and 56 (15.3%) children died during follow-up. More profound SM was associated with poor CD4% recovery (OR 1.78 for z-score <−4.5 vs. −3.5 to <−3.0, 95%CI 1.08-2.92, p=0.023) and mortality (HR 2.57 for z-score <−4.5 vs. −3.5 to <−3.0, 95%CI 1.24-5.33, p=0.011). Twenty two toxicity-associated ART modifications occurred at a rate of 2.4 per 100 patient-years and rates did not differ by malnutrition severity. Discussion Cotrimoxazole prophylaxis is important for the recovery of weight-for-age in severely malnourished children starting ART. The extent of SM does not impede weight-for-age recovery or antiretroviral tolerability but CD4% response is compromised in children with a very low weight-for-height/BMI-for-age z-score which may contribute to their high rate of mortality.

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“…Data collection methods have been described elsewhere. 23 Briefly, participating sites collect demographic, treatment, and clinical data as part of the routine clinical care of HIV patients, and transfer them to the Kirby Institute every 6 months for further analysis. TApHOD clinical sites are primarily public tertiary care hospitals based in urban settings in Cambodia, India, Indonesia, Malaysia, Thailand, and Vietnam.…”

Section: Study Populationmentioning

confidence: 99%

Prevalence, Characteristics, Management, and Outcome of Pulmonary Tuberculosis in HIV-Infected Children in the TREAT Asia Pediatric HIV Observational Database (TApHOD)

Sudjaritruk

Maleesatharn

Prasitsuebsai

et al. 2013

AIDS Patient Care and STDs

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A multicenter, retrospective, observational study was conducted to determine prevalence, characteristics, management, and outcome of pulmonary tuberculosis (PTB) in Asian HIV-infected children in the TREAT Asia Pediatric HIV Observational Database (TApHOD). Data on PTB episodes diagnosed during the period between 12 months before antiretroviral therapy (ART) initiation and December 31, 2009 were extracted. A total of 2678 HIV-infected children were included in TApHOD over a 13-year period; 457 developed PTB, giving a period prevalence of 17.1% (range 5.7-33.0% per country). There were a total of 484 PTB episodes; 27 children had 2 episodes each. There were 21 deaths (4.3%). One third of episodes (n = 175/484) occurred after ART initiation at a median of 14.1 months (interquartile range [IQR] 2.5-28.8 months). The median (IQR) CD4 + values were 9.0% (3.0-16.0%) and 183.5 (37.8-525.0) cells/mm 3 when PTB was diagnosed. Most episodes (n = 424/436, 97.3%) had abnormal radiographic findings compatible with PTB, whereas half (n = 267/484, 55.2%) presented with clinical characteristics of PTB. One third of those tested (n = 42/122, 34.4%) had bacteriological evidence of PTB. Of the 156 episodes (32.2%) that were accompanied with extrapulmonary TB, pleuritis was the most common manifestation (81.4%). After treatment completion, most episodes (n = 396/484, 81.9%) were recorded as having positive outcomes (cured, treatment completed and child well, and improvement). The prevalence of PTB among Asian HIV-infected children in our cohort was high. Children with persistent immunosuppression remain vulnerable to PTB even after ART initiation.

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Cohort Profile: The TREAT Asia Pediatric HIV Observational Database

Cited by 50 publications

References 15 publications

Incidence of AIDS-defining and Other Cancers in HIV-positive Children in South Africa

Incidence of AIDS-defining and Other Cancers in HIV-positive Children in South Africa

Antiretroviral Therapy in Severely Malnourished, HIV-infected Children in Asia

Prevalence, Characteristics, Management, and Outcome of Pulmonary Tuberculosis in HIV-Infected Children in the TREAT Asia Pediatric HIV Observational Database (TApHOD)

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