Long-term outcomes of HIV-infected children in Thailand: the Thailand Pediatric HIV Observational Database

Phongsamart, Wanatpreeya; Hansudewechakul, Rawiwan; Bunupuradah, Torsak; Klinbuayaem, Virat; Teeraananchai, Sirinya; Prasithsirikul, Wisit; Kerr, Stephen J.; Akarathum, Noppadon; Denjunta, Sukanda; Ananworanich, Jintanat; Chokephaibulkit, Kulkanya

doi:10.1016/j.ijid.2013.12.011

Cited by 24 publications

(18 citation statements)

References 12 publications

(26 reference statements)

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“…In our cohort, the cumulative probability of death was estimated to be 5.3% at 1 year after enrolment; similarly, the 12-month mortality rate was 6.6 deaths per 100 PYs of follow-up. These results are similar to other large pediatric cohort studies in SubSaharan Africa [19–24], but higher than rates found in mature Asian pediatric ART cohorts [25, 26]. A review by Peacock-Villada et al [27] synthesizing and comparing clinical outcomes from published studies of pediatric ART programs in resource-limited versus developed countries found a similar overall mean mortality of 7.6% among 30 cohorts from resource-limited countries, and 7.4% among African cohorts specifically, with most cohorts reporting on approximately 12 months of follow up time.…”

Section: Discussionsupporting

confidence: 91%

Survival Outcomes in a Pediatric Antiretroviral Treatment Cohort in Southern Malawi

et al. 2016

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BackgroundPediatric uptake and outcomes in antiretroviral treatment (ART) programmes have lagged behind adult programmes. We describe outcomes from a population-based pediatric ART cohort in rural southern Malawi.MethodsData were analyzed on children who initiated ART from October/2003 –September/2011. Demographics and diagnoses were described and survival analyses conducted to assess the impact of age, presenting features at enrolment, and drug selection.ResultsThe cohort consisted of 2203 children <15 years of age. Age at entry was <1 year for 219 (10%), 1–1.9 years for 343 (16%), 2–4.9 years for 584 (27%), and 5–15 years for 1057 (48%) patients. Initial clinical diagnoses of tuberculosis and wasting were documented for 409 (19%) and 523 (24%) patients, respectively. Median follow-up time was 1.5 years (range 0–8 years), with 3900 patient-years of follow-up. Over the period of observation, 134 patients (6%) died, 1324 (60%) remained in the cohort, 345 (16%) transferred out, and 387 (18%) defaulted. Infants <1 year of age accounted for 19% of deaths, with a 2.7-fold adjusted mortality hazard ratio relative to 5–15 year olds; median time to death was also shorter for infants (60 days) than older children (108 days). Survival analysis demonstrated younger age at ART initiation, more advanced HIV stage, and presence of tuberculosis to each be associated with shorter survival time. Among children <5 years, severe wasting (weight-for-height z-score

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Section: Discussionsupporting

confidence: 91%

Survival Outcomes in a Pediatric Antiretroviral Treatment Cohort in Southern Malawi

et al. 2016

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“…Despite late start of treatment, 2‐year mortality rates (5.1 per 100 person‐years) were good and similar to estimates reported in other sub‐Saharan African and South‐East Asian programmes . Lower death rates have been reported in Thailand (1.3 deaths/100 person‐years) , and higher estimates in rural Mozambique, where 39% LTFU and 29% death after 2 years on ART were reported among 735 children . Comparisons of mortality across settings are, however, problematic, due to disparities in undocumented deaths.…”

Section: Discussionsupporting

confidence: 68%

Mortality and clinical outcomes in children treated with antiretroviral therapy in four African vertical programmes during the first decade of paediatric HIV care, 2001–2010

Ben‐Farhat¹,

Schramm²,

Nicolay³

et al. 2017

Tropical Med Int Health

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Objective To assess mortality and clinical outcomes in children treated with antiretroviral therapy (ART) in four African vertical programmes between 2001 and 2010. Methods Cohort analysis of data from HIV‐infected children (<15 years old) initiating ART in four sub‐Saharan HIV programmes in Kenya, Uganda and Malawi, between December 2001 and December 2010. Rates of mortality, programme attrition and first‐line clinico‐immunological failure were calculated by age group (<2, 2–4 and 5–14 years), 1 or 2 years after ART initiation, and risk factors were examined. Results A total of 3949 children, 22.7% aged <2 years, 32.2% 2–4 years and 45.1% 5–14 years, were included. At ART initiation, 60.8% had clinical stage 3 or 4, and 46.5% severe immunosuppression. Overall mortality, attrition and 1‐year failure rates were 5.1, 10.8 and 9.0 per 100 person‐years, respectively. Immunosuppression, stage 3 or 4, and underweight were associated with increased rates of mortality, attrition and treatment failure. Adjusted estimates showed lower mortality hazard ratios (HR) among children aged 2–4 years (HR = 0.57, 95% CI 0.42–0.77 than children aged 5–14 years). One‐year treatment failure incidence rate ratios (IRR) were similar regardless of age (IRR = 0.91, 95% CI 0.67–1.25 for <2 years; 1.01, 95% CI 0.83–1.23 for 2–4 years, vs. 5–14 years). Conclusions Good treatment outcomes were achieved during the first decade of HIV paediatric care despite the late start of therapy. Encouraging early HIV infant diagnosis in and outside prevention of mother‐to‐child transmission programmes, and linkage to care services for early ART initiation, is needed to reduce mortality and delay treatment failure.

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“…Indeed, better survival in children with greater adherence to placebo in co-trimoxazole prophylaxis trial suggests that good adherence may be a surrogate for overall better child care [37]. Mortality at ≥2 years on cART from routine programs in RLS ranges from 3.7 to 29% [38,39] and rates vary from 1.3–6.0/100 CY [40,41]. Children still initiate treatment with severe disease with mortality remaining higher in the first year (Figure 3)[42].…”

Section: Survival On Cart In Routine Carementioning

confidence: 99%

Survival of HIV-1 vertically infected children

Davies

Gibb

Turkova

2016

Current Opinion in HIV and AIDS

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Purpose of review It is 20 years since the start of the combination antiretroviral therapy (cART) era and >10 years since cART scale-up began in resource-limited settings. We examined survival of vertically HIV-infected infants and children in the cART era. Recent findings Good survival has been achieved on cART in all settings with up to ten-fold mortality reductions compared to before cART availability. Although mortality risk remains high in the first few months after cART initiation in young children with severe disease, it drops rapidly thereafter even for those who started with advanced disease, and longer term mortality risk is low. However, suboptimal retention on cART in routine programs threatens good survival outcomes and even on treatment children continue to experience high comorbidity risk; infections remain the major cause of death. Interventions to address infection risk include co-trimoxazole prophylaxis, isoniazid preventive therapy, routine childhood and influenza immunization and improving maternal survival. Summary Pediatric survival has improved substantially with cART and HIV-infected children are aging into adulthood. It is important to ensure access to diagnosis and early cART, good program retention and optimal co-morbidity prophylaxis and treatment to achieve the best possible long-term survival and health outcomes for vertically infected children.

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Long-term outcomes of HIV-infected children in Thailand: the Thailand Pediatric HIV Observational Database

Abstract: Although most children initiated ART at low CD4 levels, the majority achieved immune reconstitution and long-term virological control. Earlier treatment may improve these outcomes.

Cited by 24 publications

References 12 publications

Survival Outcomes in a Pediatric Antiretroviral Treatment Cohort in Southern Malawi

Survival Outcomes in a Pediatric Antiretroviral Treatment Cohort in Southern Malawi

Mortality and clinical outcomes in children treated with antiretroviral therapy in four African vertical programmes during the first decade of paediatric HIV care, 2001–2010

Survival of HIV-1 vertically infected children

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