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Comparative Study
. 2013 Feb 1;62(2):208-19.
doi: 10.1097/QAI.0b013e31827b70bf.

Outcomes of antiretroviral therapy in children in Asia and Africa: a comparative analysis of the IeDEA pediatric multiregional collaboration

Valeriane Leroy  1 , Karen Malateste, Helena Rabie, Pagakrong Lumbiganon, Samuel Ayaya, Fatoumata Dicko, Mary-Ann Davies, Azar Kariminia, Kara Wools-Kaloustian, Edmond Aka, Samuel Phiri, Linda Aurpibul, Constantin Yiannoutsos, Haby Signaté-Sy, Lynne Mofenson, François Dabis; International IeDEA Pediatric Working Group1
Affiliations
Comparative Study

Outcomes of antiretroviral therapy in children in Asia and Africa: a comparative analysis of the IeDEA pediatric multiregional collaboration

Valeriane Leroy et al. J Acquir Immune Defic Syndr. .

Abstract

Background: We investigated 18-month incidence and determinants of death and loss to follow-up of children after antiretroviral therapy (ART) initiation in a multiregional collaboration in lower-income countries.

Methods: HIV-infected children (positive polymerase chain reaction <18 months or positive serology ≥18 months) from International Epidemiologic Databases to Evaluate AIDS cohorts, <16 years, initiating ART were eligible. A competing risk regression model was used to analyze the independent risk of 2 failure types: death and loss to follow-up (>6 months).

Findings: Data on 13,611 children, from Asia (N = 1454), East Africa (N = 3114), Southern Africa (N = 6212), and West Africa (N = 2881) contributed 20,417 person-years of follow-up. At 18 months, the adjusted risk of death was 4.3% in East Africa, 5.4% in Asia, 5.7% in Southern Africa, and 7.4% in West Africa (P = 0.01). Age < 24 months, World Health Organization stage 4, CD4 < 10%, attending a private sector clinic, larger cohort size, and living in West Africa were independently associated with poorer survival. The adjusted risk of loss to follow-up was 4.1% in Asia, 9.0% in Southern Africa, 14.0% in East Africa, and 21.8% in West Africa (P < 0.01). Age < 12 months, nonnucleoside reverse transcriptase inhibitor I-based ART regimen, World Health Organization stage 4 at ART start, ART initiation after 2005, attending a public sector or a nonurban clinic, having to pay for laboratory tests or antiretroviral drugs, larger cohort size, and living in East Africa or West Africa were significantly associated with higher loss to follow-up.

Conclusions: Findings differed substantially across regions but raise overall concerns about delayed ART start, low access to free HIV services for children, and increased workload on program retention in lower-income countries. Universal free access to ART services and innovative approaches are urgently needed to improve pediatric outcomes at the program level.

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Conflict of interest statement

Conflict of Interest: There are no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Estimated cumulative incidence curves with death (left panel) and loss to follow-up (LTFU) (right panel) as competing events in 13611 children on antiretroviral therapy (ART), by age group at ART initiation in the IeDEA pediatric collaboration database.
Figure 2
Figure 2. Estimated cumulative incidence curves with death (left panel) and loss to follow-up (LTFU) (right panel) as competing events in 13611 children on ART, by CD4% at ART initiation in the IeDEA pediatric collaboration database
See this image and copyright information in PMC

Comment in

References

    1. World Health Organisation, UNAIDS, Unicef. Global HIV/AIDS Response: Epidemic update and health sector progress towards Universal Access, Progress Report 2011. Geneva: WHO, UNAIDS, Unicef; 2011.
    1. Davies MA, Moultrie H, Eley B, Rabie H, Van Cutsem G, Giddy J, et al. Virologic failure and second-line antiretroviral therapy in children in South Africa--the IeDEA Southern Africa collaboration. J Acquir Immune Defic Syndr. 2011 Mar 1;56(3):270–8. - PMC - PubMed
    1. O'Brien DP, Sauvageot D, Zachariah R, Humblet P. In resource-limited settings good early outcomes can be achieved in children using adult fixed-dose combination antiretroviral therapy. AIDS. 2006 Oct 3;20(15):1955–60. - PubMed
    1. UNAIDS. Unaids report on the global AIDS epidemic 2010. Geneva: UNAIDS; 2010. Global report.
    1. Anaky MF, Duvignac J, Wemin L, Kouakoussui A, Karcher S, Toure S, et al. Scaling up antiretroviral therapy for HIV-infected children in Cote d'Ivoire: determinants of survival and loss to programme. Bull World Health Organ. 2010 Jul 1;88(7):490–9. - PMC - PubMed

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