Improving survival among Brazilian children with perinatally-acquired AIDS

Matida, Luiza Harunari; Marcopito, Luiz Francisco; Succi, Regina Célia de Menezes; Marques, Heloísa Helena de Souza; Negra, Marinella Della; Grangeiro, Alexandre; Hearst, Norman

doi:10.1590/s1413-86702004000600005

Cited by 37 publications

(34 citation statements)

References 5 publications

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“…Over the time period studied, there was a significant improvement in survival time among Brazilian children with AIDS infected through mother-to-child transmission (Figure 1), as has already been presented in a previous publication 20 . The median survival in cases diagnosed before 1988 was 20 months; this increased to 24 months in cases diagnosed between 1988 and 1992, and to 50 months in cases diagnosed between 1993 and 1994.…”

Section: Resultssupporting

confidence: 77%

“…In this 0 12 24 36 48 60 72 84 96 108 120 132 144 156 study, over the lengthy period analyzed, there was a significant improvement in the survival time among Brazilian children with AIDS that had been infected by mother-to-child transmission; more than 75% of the cases were still living four years after diagnosis among those cases diagnosed in 1997 and 1998. The national results 20,28 of survival since the date of diagnosis of AIDS in cases of mother-tochild transmission are similar to those reported in the United States, where among cases diagnosed in 1998, the survival to 36 months was 87% 37 .…”

Section: Discussionsupporting

confidence: 78%

“…Brazil has also experienced a significant increase in survival of children with AIDS 20 . In this 0 12 24 36 48 60 72 84 96 108 120 132 144 156 study, over the lengthy period analyzed, there was a significant improvement in the survival time among Brazilian children with AIDS that had been infected by mother-to-child transmission; more than 75% of the cases were still living four years after diagnosis among those cases diagnosed in 1997 and 1998.…”

Section: Discussionmentioning

confidence: 99%

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AIDS by mother-to-child transmission: survival analysis of cases followed from 1983 to 2002 in different regions of Brazil

Matida

Ramos

Moncau³

et al. 2007

Cad. Saúde Pública

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Antiretroviral therapy contributes to decreasing morbidity and mortality, and ultimately to increasing survival. In Brazil, there are regional differences in HIV epidemiology regarding pregnant women and children with HIV/AIDS. This study evaluates survival time after AIDS diagnosis in 914 children infected by mother-to-child transmission, reported between 1983 and 1998 and followed until 2002, in Brazil's five regions. Time between birth and HIV diagnosis decreased over the years, mainly in the South and Southeast Regions. There was a significant improvement in survival; more than 75% of cases were still living four years after diagnosis in the 1997-1998 group. This Brazilian study demonstrates that even with regional inequalities in health care infrastructure it is possible for a developing country to establish an effective system of universal and free access to antiretroviral therapy that produces a significant increase in survival for children with AIDS.

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Section: Resultssupporting

confidence: 77%

Section: Discussionsupporting

confidence: 78%

Section: Discussionmentioning

confidence: 99%

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AIDS by mother-to-child transmission: survival analysis of cases followed from 1983 to 2002 in different regions of Brazil

Matida

Ramos

Moncau³

et al. 2007

Cad. Saúde Pública

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“…The status of children (dead or alive) was based on the follow-up until death or the end of 2002 [15,17]. The second study was composed of 945 children with AIDS diagnosed between January 1, 1999 and December 31, 2002, followed up until death or the end of 2007 [14,16].…”

Section: Methodsmentioning

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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“…2 In the West, good outcomes are achieved for children who are on highly active antiretroviral therapy (HAART), [3][4][5][6][7] and studies indicate that similar outcomes can be achieved in resource-limited settings. [8][9][10][11] However, documented experience of treating large numbers of children remains limited.…”

Section: Methods Between June 2003 and March 2005mentioning

confidence: 99%

Effectiveness of Highly Active Antiretroviral Therapy in HIV-Positive Children: Evaluation at 12 Months in a Routine Program in Cambodia

Janssens¹,

Raleigh²,

Soeung

et al. 2007

Pediatrics

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OBJECTIVE. Increasing access to highly active antiretroviral therapy to reach all those in need in developing countries (scale up) is slowly expanding to HIV-positive children, but documented experience remains limited. We aimed to describe the clinical, immunologic, and virologic outcomes of pediatric patients with >12 months of highly active antiretroviral therapy in 2 routine programs in Cambodia. METHODS. Between June 2003 and March 2005, 212 children who were younger than 13 years started highly active antiretroviral therapy. Most patients started a standard first-line regimen of lamivudine, stavudine, and nevirapine, using split adult fixed-dosage combinations. CD4 percentage and body weight were monitored routinely. A cross-sectional virologic analysis was conducted in January 2006; genotype resistance testing was performed for patients with a detectable viral load. RESULTS. Mean age of the subjects was 6 years. Median CD4 percentage at baseline was 6. Survival was 92% at 12 months and 91% at 24 months; 13 patients died, and 4 were lost to follow-up. A total of 81% of all patients had an undetectable viral load. Among the patients with a detectable viral load, most mutations were associated with resistance to lamivudine and non–nucleoside reverse-transcriptase inhibitor drugs. Five patients had developed extensive antiretroviral resistance. Being an orphan was found to be a predictor of virologic failure. CONCLUSIONS. This study provides additional evidence of the effectiveness of integrating HIV/AIDS care with highly active antiretroviral therapy for children in a routine setting, with good virologic suppression and immunologic recovery achieved by using split adult fixed-dosage combinations. Viral load monitoring and HIV genotyping are valuable tools for the clinical follow-up of the patients. Orphans should receive careful follow-up and extra support.

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Improving survival among Brazilian children with perinatally-acquired AIDS

Abstract: Advances in management and treatment have made a great difference in the survival of Brazilian children with AIDS. These results argue strongly for making such treatment available to children in the entire developing world.

Cited by 37 publications

References 5 publications

AIDS by mother-to-child transmission: survival analysis of cases followed from 1983 to 2002 in different regions of Brazil

AIDS by mother-to-child transmission: survival analysis of cases followed from 1983 to 2002 in different regions of Brazil

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

Effectiveness of Highly Active Antiretroviral Therapy in HIV-Positive Children: Evaluation at 12 Months in a Routine Program in Cambodia

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