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. 2023 Mar 1;37(3):435-445.
doi: 10.1097/QAD.0000000000003422. Epub 2022 Nov 10.

Hospitalization among infants who initiate antiretroviral therapy before 3 months of age

Kim Anderson  1 , Victoria Iyun  1 , Brian S Eley  2 , Helena Rabie  3 , Thalia Ferreira  4 , James Nuttall  2 , Lisa Frigati  3 , Nicola Van Dongen  4 , Mary-Ann Davies  1   5 ; IeDEA-SA
Affiliations

Hospitalization among infants who initiate antiretroviral therapy before 3 months of age

Kim Anderson et al. AIDS. .

Abstract

Introduction: Studies examining hospitalization among infants with HIV in resource-limited settings, in the context of early infant diagnosis and early antiretroviral therapy (ART) initiation, are limited.

Methods: We used routinely collected data on infants who initiated ART aged <3 months (Western Cape province, South Africa; 2013-2017) to describe hospitalization from birth until 12 months post-ART initiation. Record reviews were additionally performed at three tertiary-level facilities. We used mixed-effects Poisson regression to examine factors associated with hospitalization.

Results: Among 840 infants, 579 (69%) were hospitalized; 36% had >1 hospitalization. Median age at ART initiation decreased from 57 days (interquartile range [IQR] 22-74; 2013-2015) to 19 days (IQR 5-54; 2016-2017). Early neonatal hospitalization (age <7 days) occurred in 271 infants (32%) and represented 24% of hospitalizations (272/1131). Overall, 443 infants (53%) were hospitalized at age ≥7 days, including 13% with hospitalizations pre-ART initiation, 15% pre and post-ART initiation and 25% post-ART initiation. Excluding early neonatal hospitalizations, initiating ART at older age vs. age <1 week was associated with higher hospitalization rates: adjusted incidence rate ratios (95% confidence interval) were 1.86 (1.31-2.64); 2.31 (1.62-3.29) and 2.47 (1.76-3.46) if ART initiation age was 1-4 weeks; 5-8 weeks and 9-12 weeks respectively. Among infants whose hospital records were reviewed, reasons for early neonatal hospitalizations mostly related to prematurity or low birthweight (n = 46/60; 77%) whereas hospitalizations at age ≥7 days were mostly due to infections (n = 206/243; 85%).

Conclusions: Earlier ART initiation is associated with lower hospitalization rates. High hospitalization rates, despite initiation age <3 months, is concerning.

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Figures

Figure 1.
Figure 1.
Proportion of infants with (A) viral load (VL) >1 million copies/ml and (B) CD4%<25% at ART start, by age at ART start
Figure 2.
Figure 2.
Number of hospitalisations (N=1131) per week, by time since ART initiation, among 840 infants who initiated antiretroviral treatment (ART) before the age of 3 months
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