Background Combination antiretroviral therapy (ART) has been used for HIV-infected children in many Asian countries since 2002. This study describes survival outcomes among HIV-infected children in a multicenter regional cohort in Asia. Patients and Methods Retrospective and prospective data collected through March 2009 from children in five countries enrolled in TREAT Asia's Pediatric HIV Observational Database (TApHOD) were analysed. Multivariate Cox proportional hazard models were used to assess factors associated with mortality in children who received ART. Results Among 2280 children, 1752 (77%) had received ART. During a median follow up of 3.1 years after ART, 115 (6.6%) deaths occurred, giving a crude mortality rate of 1.9 per 100 child-years (95% CI, 1.6-2.4). The mortality rate was highest in the first three months of ART (10.2 per 100 child-years; 95% CI, 7.5-13.7) and declined after 12 months (0.9 per 100 child-years; 95% CI, 0.7-1.3). Those with a low recent CD4 percentage, who started ART with lower baseline weight-for-age z-score, or with WHO clinical stage 4 had an increased risk of death. Of 528 (23%) children who never received ART, 36 (6.8%) died after presenting to care, giving a crude mortality rate of 4.1 per 100 child-years (95% CI 3.0-5.7), with a lost-to-program rate of 31.5 per 100 child-years (95% CI, 28.0-35.5). Conclusion The high mortality during the first three months of ART and in those with low CD4 percentage support the implementation of early diagnosis and ART initiation.

No abstract

Introduction We report responses to combination antiretroviral therapy (cART) in the TREAT Asia Pediatric HIV Observational Database. Methods Children included were those who had received cART (i.e., ≥3 antiretrovirals) at <18 years. The analysis was intention-to-treat by the first cART regimen. Median values are provided with interquartile ranges; hazard ratios (HR) with 95% confidence intervals. Results Of the 1655 children included, 50.4% were male, with a median age at cART of 7.0 (3.9, 9.8) years and CD4 of 8 (2.0, 15)%; 92.5% were started on an NNRTI; median duration of follow-up was 2.9 (1.4, 4.6) years. Loss-to-follow-up and death rates were 4.2 (3.7, 4.8) and 2.1 (1.7, 2.5) per 100 person-years, respectively. At 36 months, median CD4 was 26 (21, 31)%; 81% of those with viral load (N=302) were <400 copies/mL. Children who reached CD4 ≥25% within five years were more likely to be females (HR 1.4; 1.2, 1.7), start before 18 months old (HR 3.8; 2.4, 6.2), lack a history of mono/dual-therapy (HR 1.7; 1.4, 2.5), and have a higher baseline CD4 (per 10% increase: HR 2; 1.9, 2.2). Conclusion These data underscore the need for early diagnosis and cART initiation to preserve immune function.