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dc.contributor.authorFenner, Lukas*
dc.contributor.authorBrinkhof, Martin W G*
dc.contributor.authorKeiser, Olivia*
dc.contributor.authorWeigel, Ralf*
dc.contributor.authorCornell, Morna*
dc.contributor.authorMoultrie, Harry*
dc.contributor.authorProzesky, Hans*
dc.contributor.authorTechnau, Karl*
dc.contributor.authorEley, Brian*
dc.contributor.authorVaz, Paula*
dc.contributor.authorPascoe, Margaret*
dc.contributor.authorGiddy, Janet*
dc.contributor.authorVan Cutsem, Gilles*
dc.contributor.authorWood, Robin*
dc.contributor.authorEgger, Matthias*
dc.contributor.authorDavies, Mary-Ann*
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.
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
refterms.dateFOA2019-03-04T08:22:51Z
html.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.


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