Early mortality and loss to follow-up in HIV-infected children starting antiretroviral therapy in Southern Africa
Date
2010
Authors
Fenner L.
Brinkhof M.W.G.
Keiser O.
Weigel R.
Cornell M.
Moultrie H.
Prozesky H.
Technau K.
Eley B.
Vaz P.
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Journal ISSN
Volume Title
Publisher
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 ≥120 months with <18 months], CD4 cell percent (HR: 0.56; 95% CI: 0.39 to 0.78 comparing ≥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. © 2010 by Lippincott Williams & Wilkins.
Description
Keywords
efavirenz, lamivudine plus stavudine, lopinavir plus ritonavir, nevirapine, adolescent, article, CD4 lymphocyte percentage, child, childhood mortality, female, follow up, human, Human immunodeficiency virus infected patient, Human immunodeficiency virus infection, infant, major clinical study, Malawi, male, Mozambique, preschool child, priority journal, risk factor, school child, sensitivity analysis, South Africa, Zimbabwe, Africa, Southern, Age Factors, Anti-HIV Agents, Antiretroviral Therapy, Highly Active, CD4 Lymphocyte Count, Child, Child, Preschool, Female, HIV Infections, Humans, Infant, Male, Prognosis, Risk Factors, Severity of Illness Index
Citation
Journal of Acquired Immune Deficiency Syndromes
54
5
54
5