<p>Long-Term Outcomes and Risk Factors for Mortality in a Cohort of HIV-Infected Children Receiving Antiretroviral Therapy in Vietnam</p>

Abstract

Background: Management of HIV-infected children on a long-term basis is a challenge in resource-limited countries. The aim of this study is to evaluate the long-term outcome and identify the risk factors for mortality in a cohort of children with antiretroviral therapy (ART) in Vietnam. Patients and Methods: A retrospective cohort study was conducted in children aged 0-15 years, seen at the outpatient clinic of the Women and Children Hospital of An Giang, Vietnam, from August 2006 to May 2019. Cox proportional-hazard models were used to determine factors associated with mortality. Results: A total of 266 HIV-infected children were on ART. During 1545 child-years of follow-up (median follow-up was 5.8 years), 28 (10.5%) children died yielding a mortality rate of 1.8 death per 100 child-years. By multivariate analysis, World Health Organization clinical stage 3 or 4 (AHR; 7.86, 95% CI; 1.02-60.3, P= 0.047), tuberculosis (TB) coinfection (AHR; 6.26, 95% CI; 2.50-15.64, P= 0.001) and having severe immunosuppression before ART (AHR; 11.73, 95% CI; 1.52-90.4, P= 0.018) were independent factors for mortality in these children. Conclusion: Antiretroviral therapy has reduced mortality in HIV-infected children in resource-limited settings. Independent risk factors for mortality were advanced clinical stage (3 or 4), TB co-infection and severe immunosuppression. Early investigation and treatment of TB co-infection allow early ART initiation which may improve outcomes in our settings.

Survival status and its predictors among undernourished children on antiretroviral therapy in Bahir Dar city, Northwest Ethiopia, 2010 – 2020, a multicenter retrospective cohort study

“…Children presented with advanced WHO disease stages (WHO stages III and IV) were at high risk of death compared to their counterparts who presented with mild WHO clinical stages I and II. Similar findings were reported in previous studies in Ethiopia [ 18 , 25 , 31 ], Vietnam [ 47 ], Swaziland [ 48 ], India [ 40 ], Cameroon [ 49 ], Tanzania [ 39 ], and South Africa [ 50 ]. These could be explained by the fact that in these children, antiretroviral therapy initiation could result in an immune reconstitution inflammatory syndrome due to severe immune cell depletion and progressive disease [ 8 ].…”

Treatment Outcomes of HIV Infected Children After Initiation of Antiretroviral Therapy in Southwest China: An Observational Cohort Study

“…Scr thresholds using the enzymatic method were set up for different age groups: 0–7 days, 1.19 mg/ml; 7 days−1 month, 0.79 mg/ml; 1 month−1 year, 0.50 mg/ml; 1–10 years, 1.09 mg/ml; and 10–19 years, 1.29 mg/ml ( 22 ). Severe anemia was defined as a <8 g/dl of hemoglobin concentration value ( 23 ).…”

Mortality of children and adolescents co-infected with tuberculosis and HIV: a systematic review and meta-analysis

“…A comprehensive search of databases yielded a total of 6936 publications. Out of these, 37 studies [13–15,18–51] encompassing data from 115 541 children and adolescents were deemed suitable for inclusion in the systematic review and meta-analysis (Table 1 and Fig. 1).…”

“…A total of seven studies [21,24,25,33,38,43,47] provided data on mortality rates among children and adolescents with HIV-TB co-infection across various age groups. The pooled mortality rates were 32% (95% CI [24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43] for those aged <12 months, 14% (95% CI [10][11][12][13][14][15][16][17][18][19] for the 1-5 years age group, 15% (95% CI 12-17) for the 5-10 years age group, and 16% (95% CI [13][14][15][16][17][18][19][20] for those aged over 10 years old (Figure 4, Supplemental Digital Content, http://links.lww.com/QAD/D142). As illustrated in Fig.…”