Early mortality and loss to follow-up in HIV-infected children starting antiretroviral therapy in Southern Africa

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dc.contributor.authorFenner L.
dc.contributor.authorBrinkhof M.W.G.
dc.contributor.authorKeiser O.
dc.contributor.authorWeigel R.
dc.contributor.authorCornell M.
dc.contributor.authorMoultrie H.
dc.contributor.authorProzesky H.
dc.contributor.authorTechnau K.
dc.contributor.authorEley B.
dc.contributor.authorVaz P.
dc.contributor.authorPascoe M.
dc.contributor.authorGiddy J.
dc.contributor.authorVan Cutsem G.
dc.contributor.authorWood R.
dc.contributor.authorEgger M.
dc.contributor.authorDavies M.-A.
dc.date.accessioned2011-05-15T16:16:48Z
dc.date.available2011-05-15T16:16:48Z
dc.date.issued2010
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 ≥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.
dc.description.versionArticle
dc.identifier.citationJournal of Acquired Immune Deficiency Syndromes
dc.identifier.citation54
dc.identifier.citation5
dc.identifier.issn15254135
dc.identifier.other10.1097/QAI.0b013e3181e0c4cf
dc.identifier.urihttp://hdl.handle.net/10019.1/13946
dc.subjectefavirenz
dc.subjectlamivudine plus stavudine
dc.subjectlopinavir plus ritonavir
dc.subjectnevirapine
dc.subjectadolescent
dc.subjectarticle
dc.subjectCD4 lymphocyte percentage
dc.subjectchild
dc.subjectchildhood mortality
dc.subjectfemale
dc.subjectfollow up
dc.subjecthuman
dc.subjectHuman immunodeficiency virus infected patient
dc.subjectHuman immunodeficiency virus infection
dc.subjectinfant
dc.subjectmajor clinical study
dc.subjectMalawi
dc.subjectmale
dc.subjectMozambique
dc.subjectpreschool child
dc.subjectpriority journal
dc.subjectrisk factor
dc.subjectschool child
dc.subjectsensitivity analysis
dc.subjectSouth Africa
dc.subjectZimbabwe
dc.subjectAfrica, Southern
dc.subjectAge Factors
dc.subjectAnti-HIV Agents
dc.subjectAntiretroviral Therapy, Highly Active
dc.subjectCD4 Lymphocyte Count
dc.subjectChild
dc.subjectChild, Preschool
dc.subjectFemale
dc.subjectHIV Infections
dc.subjectHumans
dc.subjectInfant
dc.subjectMale
dc.subjectPrognosis
dc.subjectRisk Factors
dc.subjectSeverity of Illness Index
dc.titleEarly mortality and loss to follow-up in HIV-infected children starting antiretroviral therapy in Southern Africa
dc.typeArticle
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