Survival of HIV-Infected Children: A Cohort Study From the Asia-Pacific Region

Abstract

Background Combination antiretroviral therapy (ART) has been used for HIV-infected children in many Asian countries since 2002. This study describes survival outcomes among HIV-infected children in a multicenter regional cohort in Asia. Patients and Methods Retrospective and prospective data collected through March 2009 from children in five countries enrolled in TREAT Asia's Pediatric HIV Observational Database (TApHOD) were analysed. Multivariate Cox proportional hazard models were used to assess factors associated with mortality in children who received ART. Results Among 2280 children, 1752 (77%) had received ART. During a median follow up of 3.1 years after ART, 115 (6.6%) deaths occurred, giving a crude mortality rate of 1.9 per 100 child-years (95% CI, 1.6-2.4). The mortality rate was highest in the first three months of ART (10.2 per 100 child-years; 95% CI, 7.5-13.7) and declined after 12 months (0.9 per 100 child-years; 95% CI, 0.7-1.3). Those with a low recent CD4 percentage, who started ART with lower baseline weight-for-age z-score, or with WHO clinical stage 4 had an increased risk of death. Of 528 (23%) children who never received ART, 36 (6.8%) died after presenting to care, giving a crude mortality rate of 4.1 per 100 child-years (95% CI 3.0-5.7), with a lost-to-program rate of 31.5 per 100 child-years (95% CI, 28.0-35.5). Conclusion The high mortality during the first three months of ART and in those with low CD4 percentage support the implementation of early diagnosis and ART initiation.

Survival time of human immunodeficiency virus (HIV) infected children under 15 years of age after initiation of antiretroviral therapy in the University of Gondar Comprehensive Specialized Hospital, Ethiopia

“…A study by Brady et al (2010), Lumbiganon et al (2011) and Phongsamart et al (2013) reported that HIVinfected children with low baseline CD4 cell counts had a strong likelihood of early mortality. The results in this current study are also consistent with the findings in the above studies.…”

Tuberculosis and HIV co-infection in children

“…The survival of children in antiretroviral treatment (ART) era has dramatically improved in both resource-rich and resource-limited settings [8-12]. Although coverage with ART is improving, it is estimated that in low and middle income countries only around 34% of children aged <15 years needing ART are estimated to be receiving treatment, compared with 68% in adults [2,7,13].…”

Survival Time of Hiv-Infected Children Under 15 Years of Age After Initiation of Antiretroviral Therapy in Gondar University Hospital, Ethiopia

“…A study in [11] was found that those children with WHO clinical stage IV had an increased risk of death. Similar to our finding, studies by [13,14,15] ART at Gondar University Hospital.…”

“…Thus, mortality among these high risk groups contributed to the higher rate of mortality. A study in [10,11,12] reported that patients with low baseline CD4 cell count were a strong risk factor for early mortality of HIV-infected children. Our results are also consistent with the findings in the above studies.…”