Early mortality and loss to follow-up in HIV-infected children starting antiretroviral therapy in Southern Africa.

Hdl Handle:
http://hdl.handle.net/10144/112734
Title:
Early mortality and loss to follow-up in HIV-infected children starting antiretroviral therapy in Southern Africa.
Authors:
Fenner, Lukas; Brinkhof, Martin W G; Keiser, Olivia; Weigel, Ralf; Cornell, Morna; Moultrie, Harry; Prozesky, Hans; Technau, Karl; Eley, Brian; Vaz, Paula; Pascoe, Margaret; Giddy, Janet; Van Cutsem, Gilles; Wood, Robin; Egger, Matthias; Davies, Mary-Ann
Journal:
Journal of Acquired Immune Deficiency Syndromes (1999)
Abstract:
BACKGROUND: Many HIV-infected children in Southern Africa have been started on antiretroviral therapy (ART), but loss to follow up (LTFU) can be substantial. We analyzed mortality in children retained in care and in all children starting ART, taking LTFU into account. PATIENTS AND METHODS: Children who started ART before the age of 16 years in 10 ART programs in South Africa, Malawi, Mozambique, and Zimbabwe were included. Risk factors for death in the first year of ART were identified in Weibull models. A meta-analytic approach was used to estimate cumulative mortality at 1 year. RESULTS: Eight thousand two hundred twenty-five children (median age 49 months, median CD4 cell percent 11.6%) were included; 391 (4.8%) died and 523 (7.0%) were LTFU in the first year. Mortality at 1 year was 4.5% [95% confidence interval (CI): 2.8% to 7.4%] in children remaining in care, but 8.7% (5.4% to 12.1%) at the program level, after taking mortality in children and LTFU into account. Factors associated with mortality in children remaining in care included age [adjusted hazard ratio (HR) 0.37; 95% CI: 0.25 to 0.54 comparing > or =120 months with <18 months], CD4 cell percent (HR: 0.56; 95% CI: 0.39 to 0.78 comparing > or =20% with <10%), and clinical stage (HR: 0.12; 95% CI: 0.03 to 0.45 comparing World Health Organization stage I with III/IV). CONCLUSIONS: In children starting ART and remaining in care in Southern Africa mortality at 1 year is <5% but almost twice as high at the program level, when taking LTFU into account. Age, CD4 percentage, and clinical stage are important predictors of mortality at the individual level.
Affiliation:
Institute of Social and Preventive Medicine, University of Bern, Switzerland. lfenner@ispm.unibe.ch
Issue Date:
15-Aug-2010
URI:
http://hdl.handle.net/10144/112734
DOI:
10.1097/QAI.0b013e3181e0c4cf
PubMed ID:
20588185
Language:
en
ISSN:
1944-7884
Appears in Collections:
HIV/AIDS

Full metadata record

DC FieldValue Language
dc.contributor.authorFenner, Lukasen
dc.contributor.authorBrinkhof, Martin W Gen
dc.contributor.authorKeiser, Oliviaen
dc.contributor.authorWeigel, Ralfen
dc.contributor.authorCornell, Mornaen
dc.contributor.authorMoultrie, Harryen
dc.contributor.authorProzesky, Hansen
dc.contributor.authorTechnau, Karlen
dc.contributor.authorEley, Brianen
dc.contributor.authorVaz, Paulaen
dc.contributor.authorPascoe, Margareten
dc.contributor.authorGiddy, Janeten
dc.contributor.authorVan Cutsem, Gillesen
dc.contributor.authorWood, Robinen
dc.contributor.authorEgger, Matthiasen
dc.contributor.authorDavies, Mary-Annen
dc.date.accessioned2010-10-08T22:23:24Z-
dc.date.available2010-10-08T22:23:24Z-
dc.date.issued2010-08-15-
dc.identifier.citationEarly mortality and loss to follow-up in HIV-infected children starting antiretroviral therapy in Southern Africa. 2010, 54 (5):524-32 J. Acquir. Immune Defic. Syndr.en
dc.identifier.issn1944-7884-
dc.identifier.pmid20588185-
dc.identifier.doi10.1097/QAI.0b013e3181e0c4cf-
dc.identifier.urihttp://hdl.handle.net/10144/112734-
dc.description.abstractBACKGROUND: Many HIV-infected children in Southern Africa have been started on antiretroviral therapy (ART), but loss to follow up (LTFU) can be substantial. We analyzed mortality in children retained in care and in all children starting ART, taking LTFU into account. PATIENTS AND METHODS: Children who started ART before the age of 16 years in 10 ART programs in South Africa, Malawi, Mozambique, and Zimbabwe were included. Risk factors for death in the first year of ART were identified in Weibull models. A meta-analytic approach was used to estimate cumulative mortality at 1 year. RESULTS: Eight thousand two hundred twenty-five children (median age 49 months, median CD4 cell percent 11.6%) were included; 391 (4.8%) died and 523 (7.0%) were LTFU in the first year. Mortality at 1 year was 4.5% [95% confidence interval (CI): 2.8% to 7.4%] in children remaining in care, but 8.7% (5.4% to 12.1%) at the program level, after taking mortality in children and LTFU into account. Factors associated with mortality in children remaining in care included age [adjusted hazard ratio (HR) 0.37; 95% CI: 0.25 to 0.54 comparing > or =120 months with <18 months], CD4 cell percent (HR: 0.56; 95% CI: 0.39 to 0.78 comparing > or =20% with <10%), and clinical stage (HR: 0.12; 95% CI: 0.03 to 0.45 comparing World Health Organization stage I with III/IV). CONCLUSIONS: In children starting ART and remaining in care in Southern Africa mortality at 1 year is <5% but almost twice as high at the program level, when taking LTFU into account. Age, CD4 percentage, and clinical stage are important predictors of mortality at the individual level.en
dc.language.isoenen
dc.rightsArchived with thanks to Journal of Acquired Immune Deficiency Syndromes (1999)en
dc.subject.meshAfrica, Southernen
dc.subject.meshAge Factorsen
dc.subject.meshAnti-HIV Agentsen
dc.subject.meshAntiretroviral Therapy, Highly Activeen
dc.subject.meshCD4 Lymphocyte Counten
dc.subject.meshChilden
dc.subject.meshChild, Preschoolen
dc.subject.meshFemaleen
dc.subject.meshHIV Infectionsen
dc.subject.meshHumansen
dc.subject.meshInfanten
dc.subject.meshMaleen
dc.subject.meshPrognosisen
dc.subject.meshRisk Factorsen
dc.subject.meshSeverity of Illness Indexen
dc.titleEarly mortality and loss to follow-up in HIV-infected children starting antiretroviral therapy in Southern Africa.en
dc.contributor.departmentInstitute of Social and Preventive Medicine, University of Bern, Switzerland. lfenner@ispm.unibe.chen
dc.identifier.journalJournal of Acquired Immune Deficiency Syndromes (1999)en

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