Hospitalization and Mortality among HIV-Infected Children after Receiving Highly Active Antiretroviral Therapy

Puthanakit, Thanyawee; Aurpibul, Linda; Oberdorfer, Peninnah; Akarathum, Noppadon; Kanjananit, Suparat; Wannarit, Pornphun; Sirisanthana, Thira; Sirisanthana, Virat

doi:10.1086/510489

Cited by 113 publications

(101 citation statements)

References 15 publications

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“…Considerable efforts to control the spread of HIV in the region have been made with an increasingly higher number of people receiving free combined antiretroviral therapy (cART) (Joint United Nations Programme on HIV/AIDS & World Health Organization 2009; World Health Organization, United Nations Children's Fund, UNAIDS 2009). As a result, mortality and morbidity rates among HIV-infected children have significantly reduced (Bolton-Moore, Mubiana-Mbewe, Cantrell, Chintu, Stringer, Chi, et al 2007;Ellis & Molyneux 2007;Janssen, Ndirangu, Newell & Bland 2010;Kiboneka, Wangisi, Nabiryo, Tembe, Kusemererwa, Olupot-Olupot, et al 2008;KIDS-ART-LINC Collaboration 2009;Nyandiko, Ayaya, Nabakwe, Tenge, Sidle, Yiannoutsos, et al 2006;Puthanakit, Aurpibul, Oberdorfer, Akarathum, Kanjananit, Wannarit, et al 2007;Wamalwa, Farquhar, Obimbo, Selig, Mbori-Ngacha, Richardson, et al 2007).…”

Section: Introductionmentioning

confidence: 99%

Factors underlying taking a child to HIV care: implications for reducing loss to follow-up among HIV-infected and -exposed children

Wachira

Middlestadt²,

Vreeman³

et al. 2012

SAHARA-J: Journal of Social Aspects of HIV/AIDS

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Objective: With the aim of reducing pediatric loss to follow-up (LTFU) from HIV clinical care programs in sub-Saharan Africa, we sought to understand the personal and socio-cultural factors associated with the behavior of caregivers taking HIV-infected and -exposed children for care in western Kenya.Methods: Between May and August, 2010, in-depth interviews were conducted with 26 purposively sampled caregivers caring for HIVinfected (7), HIV-exposed (17) and HIV-unknown status (2) children, documented as LTFU from an urban and rural HIV care clinic. All were women with a majority (77%) being biological parents. Interviews were audio-recorded, transcribed and content analyzed.Results: Thematic content analysis of the women's perceptions revealed that their decision about routinely taking their children to HIV care involved multiple levels of factors including: (1) intrapersonal: transport costs, food availability, time constraints due to work commitment, disclosure of HIV status for both mother and child, perception that child is healthy and religious beliefs; (2) interpersonal: unsupportive male partner, stigma by the family and family conflicts; (3) community: cultural norms, changing community dynamics and perceived stigma; (4) health care system: clinic location, lack of patient-centered care, delays at the clinic and different appointment schedules (mother and child). Furthermore, the factors across these different levels interacted with each other in a complex way, illustrating the challenges women face in taking their children to HIV care. Conclusion:The complexity and interconnectedness of the factors underlying retention of children in HIV care perceived by these women caregivers suggests that interventions to reduce pediatric LTFU need to be holistic and address multiple socio-ecological levels. Patient-centered care that integrates a family-centered approach to HIV pediatric care is recommended.Keywords: HIV care, loss to follow-up in children, caregivers. RésuméObjectif : Dans l'objectif de réduire les perdus de vue pédiatriques dans les programmes de prise en charge clinique du VIH en Afrique subsaharienne, nous avons cherché à comprendre les facteurs personnels et socioculturels associés au comportement des aidants emmenant les enfants séropositifs et exposés au VIH à leurs sessions de traitement à l'Ouest du Kenya.Méthodes : De mai à août 2010, des entretiens détaillés ont été menés auprès de 26 aidants sélectionnés à cette fin en charge d'enfants séropositifs (7), exposés au VIH (17) et de statut sérologique inconnu (2), documentés comme perdus de vue à partir d'un centre de traitement du VIH urbain et rural. Tous étaient des femmes, et une majorité d'entre elles (77 %) étaient les parents biologiques de ces enfants. Les entretiens ont été enregistrés sur cassette, retranscrits et leur contenu analysés.Résultats : L'analyse thématique du contenu des perceptions des femmes a révélé que leurs décisions quant au fait d'emmener leurs enfants en traitement pour le VIH impliquaient des facteurs ...

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Section: Introductionmentioning

confidence: 99%

Factors underlying taking a child to HIV care: implications for reducing loss to follow-up among HIV-infected and -exposed children

Wachira

Middlestadt²,

Vreeman³

et al. 2012

SAHARA-J: Journal of Social Aspects of HIV/AIDS

View full text Add to dashboard Cite

show abstract

“…4 In this sample, hospital admissions were mostly due to infectious diseases (73.5% of cases). In most studies, pneumonia is the foremost cause of hospitalization, followed by acute diarrhea.…”

Section: Weightmentioning

confidence: 82%

“…8,13 The literature shows that the incidence of opportunistic infections has declined with the advent of HAART. 4,21 Candiani et al 21 found that no opportunistic infections occurred in their sample after the introduction of HAART.…”

Section: Weightmentioning

confidence: 93%

“…3 In addition to positive effects on growth, studies in developing countries have shown that HAART is associated with decreased morbidity, mortality, and hospitalization rates. 4 Treatment increases CD4 cell counts, decreases viral replication, and restores the immune system, consequently reducing the incidence of opportunistic infection. 5 The present study sought to assess the clinical progression of HIV-infected children receiving HAART in the city of Belo Horizonte, state of Minas Gerais, Brazil, with particular emphasis on growth parameters and hospitalization rates.…”

Section: Introductionmentioning

confidence: 99%

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Impacto da terapia antirretroviral combinada no crescimento e nas taxas de hospitalização de crianças infectadas pelo HIV

Diniz¹,

Maia²,

Amaral³

et al. 2011

J. Pediatr. (Rio J.)

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Objectives: To evaluate HAART-associated changes in growth and hospitalization rates over time in a cohort of HIV-infected children. Methods:Children starting HAART were assessed during the first 3 years of therapy. Clinical response was assessed every 24 weeks by Z scores of weight-for-age and height-for-age. Linear regression models were used to detect predictors of clinical response. Pertinent information on hospitalizations was obtained retrospectively through review of medical records.Results: A total of 196 children were assessed. Mean weight Z scores increased from -1.62 (±1.32) at baseline to -1.14 (±1.12) by week 24. Mean height z score increased from -1.88 (±1.45) at baseline to -1.66 (±1.18). Better Z scores at baseline were associated with greater increase of weight Z scores over time. Lower viral load and higher height Z scores at baseline were also associated with improved height catch-up. Eighty-five children (43.3%) were hospitalized. Most hospitalizations were prompted by infectious disease, with only two due to opportunistic infections. Conclusion:HAART was associated with significant increases in weight and height Z scores. The present study demonstrated the effectiveness of HAART in significantly reducing hospitalization, death, and incidence of opportunistic infections among HIV-infected children. Starting HAART before HIV infection can have more detrimental effects on growth and is associated with better outcomes among infected children. No conflicts of interest declared concerning the publication of this article. 132 Jornal de Pediatria -Vol. 87, No. 2, 2011 Impact of HAART on growth and hospitalization in children -Diniz LM et al.

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“…The advent of antiretroviral therapy in 1996 and the subsequent global scale-up over the following years have significantly reduced morbidity and mortality in HIV-infected children in both developed [1,2] and developing countries [3,4]. Optimizing delivery of ARV to HIV-infected children in resourcelimited countries, however, is fraught with challenges such as poor health care infrastructure, limited availability of pediatric drug formulations, lack of monitoring techniques, and competing public health priorities [5].…”

Section: Introductionmentioning

confidence: 99%

Clinical manifestations and treatment outcomes in HIV-1-infected children receiving antiretroviral therapy in Karachi, Pakistan

Mir

Qamar

Baig‐Ansari

et al. 2014

J Infect Dev Ctries

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Introduction: The impact of antiretroviral (ARV) therapy on immunological and growth parameters in HIV-positive children in Pakistan has not been reported to date. Methodology: A retrospective chart review of children diagnosed with HIV at the Sindh AIDS Control Proigramme (SACP) and registered at the Aga Khan University, Karachi, between January 2005 and 2013 was conducted, evaluating clinical and laboratory profiles of HIV+ ARV+ children for ARV impact (serial height and weight CD4 and viral counts). Results: Twenty-four children were diagnosed and registered as HIV positive over five years, and 20 were started on ARV. Six were excluded from analysis (ARV duration < 6 months). Nine (64.3%) of 14 fulfilled WHO criteria for treatment failure at a median duration of 25 weeks (IQR 18-32) on ARV and underwent resistance genotyping. All nine had NNRTI resistance, two had high-grade NRTI resistance (≥ 4 thymidine analog mutations). Median age at start of ARV was 71.5 weeks (IQR 37.5-119). Median baseline weight for age (WAZ) and height for age (HAZ) z-scores changed from -1.94 to 1.69 and -1.99 to -1.59, respectively, after six months of therapy. Median CD4 percentage and viral load at baseline changed from 13.8 to 17.8, while viral load changed from 285 × 10 4 copies to zero at six months. Conclusions: ARV improved absolute CD4 and viral counts. Weight and height did not improve significantly, highlighting the need for aggressive nutritional rehabilitation. Early development of ARV resistance in these children requires formal assessment.

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Hospitalization and Mortality among HIV-Infected Children after Receiving Highly Active Antiretroviral Therapy

Abstract: Hospitalization and mortality rates significantly decreased among HIV-infected children receiving HAART. Most hospitalizations and deaths occurred during the first 24 weeks of HAART.

Cited by 113 publications

References 15 publications

Factors underlying taking a child to HIV care: implications for reducing loss to follow-up among HIV-infected and -exposed children

Factors underlying taking a child to HIV care: implications for reducing loss to follow-up among HIV-infected and -exposed children

Impacto da terapia antirretroviral combinada no crescimento e nas taxas de hospitalização de crianças infectadas pelo HIV

Clinical manifestations and treatment outcomes in HIV-1-infected children receiving antiretroviral therapy in Karachi, Pakistan

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