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. 2011 Jun;8(6):e1001044.
doi: 10.1371/journal.pmed.1001044. Epub 2011 Jun 14.

The effect of highly active antiretroviral therapy on the survival of HIV-infected children in a resource-deprived setting: a cohort study

Andrew Edmonds  1 , Marcel Yotebieng, Jean Lusiama, Yori Matumona, Faustin Kitetele, Sonia Napravnik, Stephen R Cole, Annelies Van Rie, Frieda Behets
Affiliations

The effect of highly active antiretroviral therapy on the survival of HIV-infected children in a resource-deprived setting: a cohort study

Andrew Edmonds et al. PLoS Med. 2011 Jun.

Abstract

Background: The effect of highly active antiretroviral therapy (HAART) on the survival of HIV-infected children has not been well quantified. Because most pediatric HIV occurs in low- and middle-income countries, our objective was to provide a first estimate of this effect among children living in a resource-deprived setting.

Methods and findings: Observational data from HAART-naïve children enrolled into an HIV care and treatment program in Kinshasa, Democratic Republic of the Congo, between December 2004 and May 2010 were analyzed. We used marginal structural models to estimate the effect of HAART on survival while accounting for time-dependent confounders affected by exposure. At the start of follow-up, the median age of the 790 children was 5.9 y, 528 (66.8%) had advanced or severe immunodeficiency, and 405 (51.3%) were in HIV clinical stage 3 or 4. The children were observed for a median of 31.2 mo and contributed a total of 2,089.8 person-years. Eighty children (10.1%) died, 619 (78.4%) initiated HAART, six (0.8%) transferred to a different care provider, and 76 (9.6%) were lost to follow-up. The mortality rate was 3.2 deaths per 100 person-years (95% confidence interval [CI] 2.4-4.2) during receipt of HAART and 6.0 deaths per 100 person-years (95% CI 4.1-8.6) during receipt of primary HIV care only. The mortality hazard ratio comparing HAART with no HAART from a marginal structural model was 0.25 (95% CI 0.06-0.95).

Conclusions: HAART reduced the hazard of mortality in HIV-infected children in Kinshasa by 75%, an estimate that is similar in magnitude but with lower precision than the reported effect of HAART on survival among children in the United States. Please see later in the article for the Editors' Summary.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Number of active children by month of follow-up and HAART status.
The timing of HAART initiation, in addition to the reduction in population size over time due to death, transfer to a different care provider, or loss to follow-up, is illustrated.
Figure 2
Figure 2. Cumulative incidence curves depicting the effect of HAART on survival among 790 HIV-infected children.
In (A), the curves are unweighted. In (B), the curves are weighted by the IPTCV.
See this image and copyright information in PMC

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