Early Antiretroviral Therapy Initiation and Mortality Among Infants Diagnosed With HIV in the First 12 Weeks of Life

Sheahan, Anna; Feinstein, Lydia; Dube, Queen; Edmonds, Andrew; Chirambo, Chawanangwa; Smith, Emily R.; Behets, Frieda; Heyderman, Robert S.; Rie, Annelies Van

doi:10.1097/inf.0000000000001539

Cited by 6 publications

(6 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…As found in other studies, the greatest risk of mortality occurred in the first 12 months of treatment [29,30], among children who were underweight at ART initiation [18], and among infants [31][32][33][34][35][36]. Higher mortality among infants was expected due to a survival bias among older children, but biological factors may also have contributed, with more rapid disease progression and higher mortality among infants infected in utero or peripartum [37], and suboptimal pediatric dosing and adherence in the younger age groups.…”

Section: Discussionmentioning

confidence: 59%

Treatment outcomes among children younger than five years living with HIV in rural Zambia, 2008–2018: a cohort study

et al. 2021

View full text Add to dashboard Cite

Background HIV testing and treatment guidelines for children in sub-Saharan Africa have evolved over time, such that children are now treated at younger ages. The objective of this study was to describe the treatment experience for immunologic, virologic, and growth outcomes among HIV-infected Zambian children younger than 5 years of age from 2008 to 2018. Methods Participants enrolled in a clinical cohort study in Macha, Zambia and initiating antiretroviral treatment before 5 years of age between 2008 and 2015 were included in the analysis and followed up to the end of 2018. Outcomes, including growth, CD4+ T-cell percentage, viral suppression, and mortality, were evaluated among all children using longitudinal and survival analyses. Comparisons by age at treatment initiation (< 1, 1 to < 2, and 2 to < 5 years) were also evaluated. Results Three hundred eighty-one children initiating treatment before 5 years of age between 2008 and 2015 were included in the analysis. Growth metrics and CD4+ T-cell percentage improved over time after treatment initiation. However, 20% of children remained underweight and 40% of children remained stunted after the first 36 months of treatment. 85% of children had a viral load < 400 copies/mL after 12 months of treatment. However, children < 1 year at treatment initiation were more likely to have a detectable viral load in the first 12 months of treatment and less likely to achieve viral suppression compared to older children. Mortality was highest in the first 12 months of treatment, among underweight children, and among children initiating treatment in 2008–2010 compared to 2011–2015. Conclusions Most children initiating antiretroviral treatment from 2008 to 2015 in rural Zambia responded well to treatment. However, many children remained underweight and stunted, and experienced high mortality rates during the first few months of treatment. This supports continued efforts to improve early infant diagnosis, nutritional support, and pediatric drug formulations.

show abstract

Section: Discussionmentioning

confidence: 59%

Treatment outcomes among children younger than five years living with HIV in rural Zambia, 2008–2018: a cohort study

et al. 2021

View full text Add to dashboard Cite

show abstract

“…In our study, the mean age at PCR in children varied from 3.3 to 8.5 months, the main entry point was PMTCT (99.5%). The median age at the start of the DBS analysis was earlier in Lomé of 77 days [4], comparable to the 2.4 months observed in Equatorial Guinea [14] whereas it was 7 weeks in Congo Kinshasa [22].…”

Section: Results Of Hiv Early Infant Diagnosismentioning

confidence: 77%

“…This rate varies according to the type, place and period of study, but increasingly decreasing: 6.7% in Benin in 2010, 2.5% in Lomé (Togo) in 2011 and 2.9% In Equatorial Guinea in 2013 [5,10,14]. While EID is the key to early initiation of HAART and the reduction of mortality associated with HIV infection, the authors emphasize the complexity of translating the results of clinical trials and WHO guidelines into the practice, initiation of ART is often slow [14,22,23]. During 2011-2015, the total number of HIV diagnostic tests performed among HIV-exposed infants within 6 weeks after birth increased in the seven PEPFAR countries studied, however, the rate of testing for EID among HIV-exposed infants was less than 50% in five countries in 2015 [24].…”

Section: Results Of Hiv Early Infant Diagnosismentioning

confidence: 99%

Assessment of the Early Infant Diagnosis of HIV Infection in Togo in 2014

Azoumah¹,

Agbeko²,

Kar³

et al. 2017

J AIDS Clin Res

View full text Add to dashboard Cite

“…Early diagnosis and timely initiation of treatment, substantially improves survival 2 . Untreated HIV in children results in growth delays that may not be reversed by ART [ 15 , 16 ]. It is, therefore, crucial to have reliable estimates of Pediatric HIV, to plan, implement and monitor the coverage of prevention and care programs for children living with HIV.…”

Section: Introductionmentioning

confidence: 99%

Estimating the burden of pediatric HIV in an ‘A’ category district in India: an epidemiological study

Sinha

Washington²,

Sethumadhavan

et al. 2021

BMC Pediatr

View full text Add to dashboard Cite

Background India lacks epidemiological information on the disease burden of pediatric HIV. The National AIDS Control Program (NACP) estimates the numbers of HIV-positive children as a proportion of adult persons living with HIV. A third of HIV-positive children die before their first birthday and a half before they reach their second birthday. The early detection of HIV is crucial for the prevention of morbidities, growth delays, and death among HIV-positive children. Methods The study aimed to estimate the disease burden of pediatric HIV among children in ‘A’ category district of a high HIV prevalence state. An ‘A’ category district is defined by the presence of > 1% HIV prevalence among the general population, as estimated by HIV Sentinel Surveillance. The study used an innovative three-pronged strategy combining cross-sectional and longitudinal methods. The overall burden of pediatric HIV was calculated as a product of cases detected multiplied by a net inflation factor, for each of three strategies. Results The existing pool of HIV infection in the district is estimated to be 3266 (95% CI: 2621–4197) HIV positive children < 15 years of age, in a mid-year (2013) projected child population of about 1.4 million, thus giving an HIV prevalence of 0.23% (CI: 0.19–0.30) among children (0–14 years of age). The proportion of children among all people living with HIV in the district works out to 10.4% (CI: 8.6–13.5%). Conclusions The study estimate of 0.23% HIV prevalence among children (0–14 years of age) is higher than the NACP estimates (0.02) and is 2.5 higher than the Karnataka state estimate (0.09)22. Similarly, the proportion of children among all persons living with HIV in Belgaum district is 10.4% in this study, as against 6.54% for India. The study methodology is replicable for other settings and other diseases.

show abstract

Early Antiretroviral Therapy Initiation and Mortality Among Infants Diagnosed With HIV in the First 12 Weeks of Life

Cited by 6 publications

References 26 publications

Treatment outcomes among children younger than five years living with HIV in rural Zambia, 2008–2018: a cohort study

Treatment outcomes among children younger than five years living with HIV in rural Zambia, 2008–2018: a cohort study

Assessment of the Early Infant Diagnosis of HIV Infection in Togo in 2014

Estimating the burden of pediatric HIV in an ‘A’ category district in India: an epidemiological study

Contact Info

Product

Resources

About