Effectiveness of antiretroviral therapy among HIV-infected children in sub-Saharan Africa

Sutcliffe, Catherine G.; Dijk, Janneke H. van; Bolton, Carolyn; Persaud, Deborah; Moss, William J.

doi:10.1016/s1473-3099(08)70180-4

Cited by 240 publications

(257 citation statements)

References 46 publications

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“…Children who died exhibited the following high-risk characteristics: dual HIV/TB disease; young age (<6 months); recent ART initiation (<3 months on ART); and severe immunological suppression in infants <15 months of age. Similar trends in mortality have been noted in numerous studies, [18,28,30,31] providing further evidence of a focused time period among high-risk patients who may be ideal for a targeted intervention. Intensified surveillance of this population would ideally result in expedited referral to higher levels of care and decreased mortality.…”

Section: Discussionsupporting

confidence: 82%

“…Children receiving ongoing treatment within the PHC network demonstrated sustained indices of effective HIV management (high VL suppression rates, rapid immune reconstitution, low mortality rates) which are comparable with, if not better than, those in previously published studies of similar cohorts. [17,[25][26][27][28][29] Overall mortality in the cohort was low. Children who died exhibited the following high-risk characteristics: dual HIV/TB disease; young age (<6 months); recent ART initiation (<3 months on ART); and severe immunological suppression in infants <15 months of age.…”

Section: Discussionmentioning

confidence: 99%

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Paediatric ART outcomes in a decentralised model of care in Cape Town, South Africa

Morsheimer

Dramowski

Rabie

et al. 2014

South. Afr. j. HIV med.

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Background. Although subSaharan Africa faces the world's largest paediatric HIV epidemic, only 1 in 4 children has access to combination antiretroviral therapy (ART). A decentralised approach to HIV care is advocated, but programmes in resourcelimited settings encounter many challenges to community-initiated paediatric ART implementation. + , viral load (VL) levels and status at study closure were collected. Results. Two subgroups were identified: children who were initiated on ART in a PHC clinic (n=343) and children who were down-referred from tertiary hospitals (n=270). The numbers of children initiated on ART in PHC increased sevenfold over the study period. Down-referred children were severely ill at ART initiation, with higher VLs, lower CD4 + counts and higher rates of tuberculosis co-infection (25.3% v. 16.9%; p=0.01). Median time to virological suppression was 29 weeks in PHC-ART initiates and 44 weeks in children down-referred (p<0.0001). Children down-referred to PHC either maintained or gained virological suppression. Longitudinal cohort analysis demonstrated sustained VL suppression >80%, high rates of immune reconstitution and low mortality. Conclusions. Increasing numbers of children are initiated on ART in PHC settings and achieve comparable immunological, virological and survival outcomes, suggesting successful decentralisation of paediatric HIV care. Down-referral of children with adherence-related virological failure may assist with attainment of virological suppression and sparing use of second-line medications.

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Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Paediatric ART outcomes in a decentralised model of care in Cape Town, South Africa

Morsheimer

Dramowski

Rabie

et al. 2014

South. Afr. j. HIV med.

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“…Early initiation of ART improves viral, immune, growth responses and survival in HIV infected children [23,24] . Sutcliffe et al compiled data from multiple cohorts of infected children from resource limited settings and reported a median age at ART initiation of 5 years [24] .…”

Section: Discussionmentioning

confidence: 99%

“…Sutcliffe et al compiled data from multiple cohorts of infected children from resource limited settings and reported a median age at ART initiation of 5 years [24] . Median age at initiation of ART was 67 months in children of our study.…”

Section: Discussionmentioning

confidence: 99%

Profile of HIV infected children: A hospital based study at Eastern Nepal

Poudel

Pokharel

Chitlangia

et al. 2014

Asian Pacific Journal of Tropical Disease

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“…The impact of HAART on the reduction of progression to AIDS in children has been described repeatedly [2,3,5,8,10,22-24], even in developing countries [25-27]. However, few population-based studies have evaluated changes in the pattern of occurrence of diseases associated with HIV/AIDS [11,18,28,29].…”

Section: Discussionmentioning

confidence: 99%

Opportunistic illnesses in Brazilian children with AIDS: results from two national cohort studies, 1983-2007

Ramos

Matida²,

Hearst

et al. 2011

AIDS Res Ther

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BackgroundHAART has significantly reduced AIDS-related morbidity in children. However, limited evidence is available from developing countries regarding patterns of opportunistic illnesses. We describe these events and their associated factors in children with AIDS in Brazil.MethodsThis study is based on two representative retrospective multi-center cohorts including a total 1,859 children with AIDS, infected via mother-to-child transmission (MTCT), between 1983-2002. Opportunistic illnesses were described and analyzed over time. The association of demographic, clinical and operational data with the occurrence of opportunistic diseases was assessed.ResultsIn total, 1,218 (65.5%) had at least one event of an opportunistic disease. Variables significantly associated with occurrence of these events included: region of residence (OR 2.68-11.33, as compared to the Northern region), age < 1 year at diagnosis (OR 2.56, 95% CI 1.81-3.61, p < 0.001), and non-performance of MTCT prevention measures (OR 1.58, 95% CI 1.21-2.07, p < 0.001). Protective factors included year of HIV diagnosis in the HAART era (OR 0.34, 95% CI 0.15-0.76, p = 0.009) and ART use (OR 0.58, 95% CI 0.44-0.77, p < 0.001). In both periods bacterial infections represented the most common opportunistic events (58.6 vs. 34.7%; p < 0.001), followed by Pneumocystis jirovecii pneumonia (21.9 vs. 13.2%; p < 0.001), and bacterial meningitis/sepsis (16.8 vs. 7.4%; p < 0.001).ConclusionsDespite the significant reduction in recent years, opportunistic illnesses are still common in Brazilian children with AIDS in the HAART era, especially bacterial diseases. The data reinforce the need for scaling up prevention of MTCT, early diagnosis of infection, and improvement of comprehensive pediatric care.

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Effectiveness of antiretroviral therapy among HIV-infected children in sub-Saharan Africa

Cited by 240 publications

References 46 publications

Paediatric ART outcomes in a decentralised model of care in Cape Town, South Africa

Paediatric ART outcomes in a decentralised model of care in Cape Town, South Africa

Profile of HIV infected children: A hospital based study at Eastern Nepal

Opportunistic illnesses in Brazilian children with AIDS: results from two national cohort studies, 1983-2007

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