A survey of paediatric HIV programmatic and clinical management practices in Asia and sub‐Saharan Africa—the International epidemiologic Databases to Evaluate AIDS (IeDEA)

Saphonn, Vonthanak; Vibol, Ung; Kumarasamy, Nagalingeswaran; Kurniati, Nia; Fong, Siew Moy; Yusoff, Nik Khairulddin Nik; Razali, Kamarul Azahar Mohd; Nallusamy, Revathy; Sirisanthana, Virat; Hansudewechakul, Rawiwan; Lumbiganon, Pagakrong; Ananworanich, Jintanat; Chokephaibulkit, Kulkanya; Truong, Huu Khanh; Do, C. V.; Huy, Bùi Vũ; Law, Matthew; Chimbetete, Cleophas; Eley, Brian; Garone, Daniele; Giddy, Janet; Moultrie, Harry; Phiri, Sam; Prozesky, Hans; Technau, Karl-Günter; Wood, Robin; Dabis, François; Bissagnené, E.; Zannou, Marcel; Drabo, Joseph; Eholié, Serge; Peterson, Kevin; Renner, Lorna; Maïga, M. Y.; Charurat, Man; Sy, Haby Signaté; Ekouévi, Didier K.; Jaquet, Antoine; Leroy, Valériane; Lewden, Charlotte; Sohn, Annette H.

doi:10.7448/ias.16.1.17998

Cited by 35 publications

(24 citation statements)

References 12 publications

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“…In contrast, for children the chance of VL suppression did not differ across regions which may indicate less between-region heterogeneity and less variations in both patient-level and site-specific factors. High clinical resources and access to paediatric antiretroviral formulations were reported in a survey of paediatric HIV programmatic and clinical management practices in Asia and sub-Saharan Africa 24 .…”

Section: Discussionmentioning

confidence: 99%

HIV Viral Load Suppression in Adults and Children Receiving Antiretroviral Therapy—Results From the IeDEA Collaboration

Jiamsakul

Kariminia

Althoff

et al. 2017

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background Having 90% of patients on antiretroviral therapy (ART) and achieving an undetectable viral load (VL) is one of the 90:90:90 by 2020 targets. In this global analysis, we investigated the proportions of adult and paediatric patients with VL suppression in the first three years after ART initiation. Methods Patients from the IeDEA cohorts who initiated ART between 2010 and 2014 were included. Proportions with VL suppression (<1000 copies/mL) were estimated using: (i) strict intention-to-treat (ITT) – loss to follow-up (LTFU) and dead patients counted as having detectable VL; and (ii) modified ITT – LTFU and dead patients were excluded. Logistic regression was used to identify predictors of viral suppression at one year after ART initiation using modified ITT. Results A total of 35561 adults from 38 sites/16 countries and 2601 children from 18 sites/6 countries were included. When comparing strict with modified ITT methods, the proportion achieving VL suppression at three years from ART initiation changed from 45.1% to 90.2% in adults, and 60.6% to 80.4% in children. In adults, older age, higher CD4 count pre-ART, and homosexual/bisexual HIV exposure were associated VL suppression. In children, older age and higher CD4 percentage pre-ART showed significant associations with VL suppression. Conclusions Large increases in the proportion of VL suppression in adults were observed when we excluded those who were LTFU or had died. The increases were less pronounced in children. Greater emphasis should be made to minimise LTFU and maximise patient retention in HIV-infected patients of all age groups.

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Section: Discussionmentioning

confidence: 99%

HIV Viral Load Suppression in Adults and Children Receiving Antiretroviral Therapy—Results From the IeDEA Collaboration

Jiamsakul

Kariminia

Althoff

et al. 2017

JAIDS Journal of Acquired Immune Deficiency Syndromes

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“…These sites are predominantly public or university-based pediatric HIV referral clinics. A 2010 survey of ten TApHOD sites found that only 30% provide food supplementation for malnourished patients, 13 however, nutritional aid (milk/formula, rice, or cash) is usually provided to children in need through local governments in the region. The same survey also indicated that 90% of sites provide nutritional counselling to patients and their caregivers, 80% provide micronutrients for patients, and 60% routinely initiate cotrimoxazole prophylaxis in HIV-exposed infants (unpublished results).…”

Section: Methodsmentioning

confidence: 99%

Antiretroviral Therapy in Severely Malnourished, HIV-infected Children in Asia

Boettiger

Aurpibul

Hudaya

et al. 2016

Pediatric Infectious Disease Journal

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Background Information on antiretroviral therapy (ART) use in HIV-infected children with severe malnutrition (SM) is lacking. We investigated long-term ART outcomes in this population. Methods Children enrolled in the TREAT Asia Pediatric HIV Observational Database who had SM (weight-for-height or BMI-for-age z-score <−3) at ART initiation were analyzed. Generalized estimating equations were used to investigate poor weight recovery (weight-for-age z-score <−3) and poor CD4% recovery (CD4% <25), and competing risk regression was used to analyze mortality and toxicity-associated treatment modification. Results Three hundred fifty five (11.9%) of 2993 children starting ART had SM. Their median weight-for-age z-score increased from −5.6 at ART initiation to −2.3 after 36 months. Not using cotrimoxazole prophylaxis at baseline was associated with poor weight recovery (OR 2.49 vs. using, 95%CI 1.66-3.74, p<0.001). Median CD4% increased from 3.0 at ART initiation to 27.2 after 36 months, and 56 (15.3%) children died during follow-up. More profound SM was associated with poor CD4% recovery (OR 1.78 for z-score <−4.5 vs. −3.5 to <−3.0, 95%CI 1.08-2.92, p=0.023) and mortality (HR 2.57 for z-score <−4.5 vs. −3.5 to <−3.0, 95%CI 1.24-5.33, p=0.011). Twenty two toxicity-associated ART modifications occurred at a rate of 2.4 per 100 patient-years and rates did not differ by malnutrition severity. Discussion Cotrimoxazole prophylaxis is important for the recovery of weight-for-age in severely malnourished children starting ART. The extent of SM does not impede weight-for-age recovery or antiretroviral tolerability but CD4% response is compromised in children with a very low weight-for-height/BMI-for-age z-score which may contribute to their high rate of mortality.

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“…The seven regions included in IeDEA are North America, Caribbean/Central and South America, Asia/Pacific, and four regions in sub-Saharan Africa (East Africa, West Africa, Central Africa and Southern Africa). 6,10-14 For the present analysis we included data from the African and Asia/Pacific regions of IeDEA. In addition, we included North American and Latin American data from the NICHD International Site Development Initiative (NISDI), 15 the Pediatric HIV/AIDS Cohort Study (PHACS), 16 and the International Maternal Pediatric Adolescent AIDS Clinical Trials (IMPAACT) 219C study.…”

Section: Methodsmentioning

confidence: 99%

Immunodeficiency in Children Starting Antiretroviral Therapy in Low-, Middle-, and High-Income Countries

Koller

Patel

Benjamin

et al. 2015

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background The CD4 cell count or percent (CD4%) at the start of combination antiretroviral therapy (cART) are important prognostic factors in children starting therapy and an important indicator of program performance. We describe trends and determinants of CD4 measures at cART initiation in children from low-, middle- and high-income countries. Methods We included children aged <16 years from clinics participating in a collaborative study spanning sub-Saharan Africa, Asia, Latin America and the United States of America (USA). Missing CD4 values at cART start were estimated through multiple imputation. Severe immunodeficiency was defined according to World Health Organization criteria. Analyses used generalized additive mixed models adjusted for age, country and calendar year. Results 34,706 children from nine low-income, six lower middle-income, four upper middle-income countries and one high-income country (United States of America, USA) were included; 20,624 children (59%) had severe immunodeficiency. In low-income countries the estimated prevalence of children starting cART with severe immunodeficiency declined from 76% in 2004 to 63% in 2010. Corresponding figures for lower middle-income countries were from 77% to 66% and for upper middle-income countries from 75% to 58%. In the USA, the percentage decreased from 42% to 19% during the period 1996 to 2006. In low- and middle-income countries infants and children aged 12-15 years had the highest prevalence of severe immunodeficiency at cART initiation. Conclusions Despite progress in most low- and middle-income countries, many children continue to start cART with severe immunodeficiency. Early diagnosis and treatment of HIV-infected children to prevent morbidity and mortality associated with immunodeficiency must remain a global public health priority.

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A survey of paediatric HIV programmatic and clinical management practices in Asia and sub‐Saharan Africa—the International epidemiologic Databases to Evaluate AIDS (IeDEA)

Cited by 35 publications

References 12 publications

HIV Viral Load Suppression in Adults and Children Receiving Antiretroviral Therapy—Results From the IeDEA Collaboration

HIV Viral Load Suppression in Adults and Children Receiving Antiretroviral Therapy—Results From the IeDEA Collaboration

Antiretroviral Therapy in Severely Malnourished, HIV-infected Children in Asia

Immunodeficiency in Children Starting Antiretroviral Therapy in Low-, Middle-, and High-Income Countries

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