Outcomes of human immunodeficiency virus‐infected children after anti‐retroviral therapy in <scp>M</scp>alaysia

Moy, F.; Fahey, Paul; Yusoff, Nik K N; Razali, Kamarul Azahar Mohd; Nallusamy, Revathy

doi:10.1111/jpc.12712

Cited by 7 publications

(10 citation statements)

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“…Children, who had CD4 counts or percents below the threshold, yet another strong predictor of mortality, showed a higher risk of death than their counterparts. This finding is consistent with other previous studies conducted in Ethiopia [ 1 , 17 , 23 ], India [ 32 ], Congo [ 33 ], Tanzania [ 31 ], Bangladesh [ 34 ] and Malaysia [ 35 ]which all indicate that low CD4 count was an independent predictor of mortality. Children with severe immunodeficiency are at higher risk of developing serious and life-threatening opportunistic infections, such as CNS toxoplasmosis and cryptococcal meningitis.…”

Section: Discussionsupporting

confidence: 93%

Effects of undernutrition on survival of human immunodeficiency virus positive children on antiretroviral therapy

et al. 2018

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BackgroundThe relationship between undernutrition and HIV is bidirectional, ultimately contributing to quality of life and survival of affected individuals. Ethiopia is a sub-Saharan nation influenced by both undernutrition and HIV. In Ethiopia, although individuals are often dually impacted, the effect of undernutrition on the survival of HIV positive children on anti-retroviral therapy (ART) has not been well investigated. Therefore, this study assessed the effect of undernutrition on survival rates of HIV positive children on ART in Amhara Regional State of Ethiopia.MethodsAn institution-based retrospective cohort study was conducted among 390 HIV positive children on ART from the 1st of January, 2012 to the 28th of February, 2017 in Amhara Regional State Referral Hospitals. A simple random sampling technique was used to select the study participants. Data were extracted by reviewing patients’ ART intake and follow-up forms. Data were entered into Epi-Data Version 3.1, and analysis was done using STATA Version 13. The Kaplan-Meier survival curve was used to estimate the cumulative survival time of the sample. Log rank tests were employed to compare the survival time between different categories of explanatory variables. Bivariable and multivariable Cox proportional hazards models were fitted to identify predictors of mortality.ResultsAmong the 390 records included in the final analysis, 9.7% of the individuals died within the follow-up period. In this study, the overall mortality rate was found to be 4.4 per 100 child-years (95% CI: 3.2, 6.0) while undernourished children had a lower survival time than well-nourished children. Low hemoglobin level (AHR: 3.2, 95% CI: 1.4, 7.4), CD4 cell count or percent below the threshold (AHR: 5.2, 95% CI: 1.9, 14.1), severe stunting (AHR: 3.9, 95% CI: 1.7, 9.4), severe wasting (AHR: 3.0, 95% CI: 1.3, 6.9) and advanced disease stage (III and IV) (AHR: 2.6, 95% CI: 1.1, 6.6) were found to be predictors of mortality.ConclusionThere was a high rate of mortality. A significant difference was observed in the survival rate of undernourished and well-nourished children. Low hemoglobin level, CD4 count or percent below the threshold, severe wasting, severe stunting, and advanced disease stage were found to be predictors of mortality.

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Section: Discussionsupporting

confidence: 93%

Effects of undernutrition on survival of human immunodeficiency virus positive children on antiretroviral therapy

et al. 2018

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“…The mortality rate in our study is lower than the rates of 2.25, 3.0 4.0, 4.7, and 8.4 per 100 child-years reported in Malawi, Lesotho, and Swaziland, 30 in Nigeria, 31 in Ethiopia, 27 in South Africa, 25 and in Kenya, 32 respectively. It is also lower than the rate in other reports from in Asian countries such as China (2.31 per 100 child-years), 9 Malaysia (2.86 per 100 child-years) 8 and India (4.4–4.9 per 100 person-years). 10 The outcome of this study is similar to that of Lumbiganon et al 7 who studied 2280 children in 5 countries in the Asia-Pacific region, including Vietnam.…”

Section: Discussioncontrasting

confidence: 60%

“…ART programs for HIV-infected children in Asian countries have been shown to be effective, with mortality rates ranging from 1.9 child-years to 4.9 child-years. [7][8][9][10][11] The common risk factors for mortality were a low CD4 percentage, WHO clinical stage 3 or 4 and malnutrition. [8][9][10]12 In a cohort of 266 HIV-infected children with suspected tuberculosis (TB) in four countries (Burkina Faso, Cambodia, Cameroon, and Vietnam), Marcy et al found that TB, young age, CD4 less than 10%, miliary features, and elevated serum transaminases were all independent predictors of mortality.…”

Section: Introductionmentioning

confidence: 99%

“…[7][8][9][10][11] The common risk factors for mortality were a low CD4 percentage, WHO clinical stage 3 or 4 and malnutrition. [8][9][10]12 In a cohort of 266 HIV-infected children with suspected tuberculosis (TB) in four countries (Burkina Faso, Cambodia, Cameroon, and Vietnam), Marcy et al found that TB, young age, CD4 less than 10%, miliary features, and elevated serum transaminases were all independent predictors of mortality. 13 In Vietnam, by the end of 2011, there were 3200 Vietnamese children with HIV/AIDS receiving ART; However, there were a few reports on ART outcomes among HIV-infected children [14][15][16] In a study of 86 children on ART in Hanoi, Vietnam, Pham et al reported that the success rate (plasma HIV-1 viral load <1000 copies/mL) was 79.1% after 2-year follow-up.…”

Section: Introductionmentioning

confidence: 99%

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

Nguyen¹,

Ton²,

Luong³

et al. 2020

HIV

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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.

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“…Besides, a Brazilian study also reported that baseline CD4 count below 15% significantly increased the hazard of death among HIV-positive children [ 33 ]. Similarly, studies conducted elsewhere have documented that HIV-positive children with low CD4 count were at higher risk of mortality than those who had high CD4 count [ 28 , 34 – 36 ]. Generally, serious and life-threatening OIs, including CNS toxoplasmosis and cryptococcal meningitis are frequent among people having low CD4 count or percentages which increases their vulnerability to death.…”

Section: Discussionmentioning

confidence: 98%

Mortality rate among HIV-positive children on ART in Northwest Ethiopia: a historical cohort study

et al. 2020

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Background Though highly active antiretroviral therapy (HAART) has been available for more than a decade in Ethiopia, information regarding mortality rates of human immunodeficiency virus (HIV)-positive children after antiretroviral therapy antiretroviral therapy (ART) initiation is very scarce. Thus, this study intends to determine the predictors of mortality among HIV-positive children receiving ART in Amhara Region. Methods A multicenter facility-based historical cohort study was conducted in 538 HIV-positive children on ART from January 2012 to February 2017. We employed a standardized data extraction tool, adapted from ART entry and follow-up forms. Descriptive analyses were summarized using the Kaplan-Meier survival curve and log rank test. Then, the Cox-proportional hazard regression model was employed to estimate the hazard of death up to five-years after ART initiation. Variables with p -values ≤0.25 in bivariable analysis were candidates to the multivariable analysis. Finally, variables with p-values < 0.05 were considered as significant variables. Results The cohort contributed a total follow-up time of 14,600 child-months, with an overall mortality rate of 3.2 (95% CI: 2.3, 4.3) per 100 child-years. This study also indicated that HIV-infected children presenting with opportunistic infections (OIs) (AHR: 2.5 , 95% CI: 1.04, 5.9), anemia (AHR: 3.1, 95% CI: 1.4, 6.7), severe immunodeficiency (AHR: 4.4, 95% CI: 1.7, 11.7), severe stunting (AHR: 3.3, 95% CI: 1.4, 8.0), severe wasting (AHR: 3.1, 95% CI: 1.3, 7.3), and advanced disease staging (III and IV) (AHR: 3.0, 95% CI: 1.2, 7.1) were at higher risk of mortality. Conclusion A higher rate of mortality was observed in our study as compared to previous Ethiopian studies. HIV-positive children presenting with anemia, OIs, severe immunodeficiency, advanced disease staging (III and IV), severe stunting, and severe wasting were at higher risk of mortality.

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Outcomes of human immunodeficiency virus‐infected children after anti‐retroviral therapy in Malaysia

Cited by 7 publications

References 10 publications

Effects of undernutrition on survival of human immunodeficiency virus positive children on antiretroviral therapy

Effects of undernutrition on survival of human immunodeficiency virus positive children on antiretroviral therapy

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

Mortality rate among HIV-positive children on ART in Northwest Ethiopia: a historical cohort study

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