Long‐Term Survival of HIV‐Infected Children Receiving Antiretroviral Therapy in Thailand: A 5‐Year Observational Cohort Study

Collins, Intira Jeannie; Jourdain, Gonzague; Hansudewechakul, Rawiwan; Kanjanavanit, Suparat; Hongsiriwon, Suchat; Ngampiyasakul, Chaiwat; Sriminiphant, Somboon; Technakunakorn, Pornchai; Ngo‐Giang‐Huong, Nicole; Duong, Trinh; Cœur, Sophie Le; Jaffar, Shabbar; Lallemant, Marc; Team, Treatment Study

doi:10.1086/657401

Cited by 57 publications

(55 citation statements)

References 29 publications

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“…Over 75% of the children had viral log copies > 5.0 at baseline and after 12 weeks of HAART 66% of the children had an undetectable viral load (<400 copies per mL). These findings are consistent with the other studies findings which have shown that HAART with generic adult FDC are safe and effective for HIV-infected children in resource limited settings, despite initiation of treatment during advanced stages of the disease 7,11,12,21 . Among the children who failed therapy in the study, caregiver, and age were not significant risk factors for virologic failure in this study group.…”

Section: Discussionsupporting

confidence: 93%

“…In addition there appears to be poor immunologic reconstitution among the children who initiated ART with CD4 cell count <5%. These findings are similar to those reported in another Ugandan cohort of children which reported poor CD4 recovery compared to those in United Kingdom/Ireland probably due to lower CD4 cell count at ART initiation 28 A recent study from Thailand also reported that children with low CD4 percent and wasting at baseline were at high risk of mortality during the first 6 months of therapy 21 . These findings support the 2010 WHO recommendation of initiation of ART for children between 24-59 months at CD4<25% and those 5 years and older at CD4 absolute count<350 cells/ mm 3 , which was based on longitudinal data 29,30 .…”

Section: Discussionsupporting

confidence: 84%

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The long-term effectiveness of generic adult fixed-dose combination antiretroviral therapy for HIV-infected Ugandan children

Barlow-Mosha¹,

Bagenda²,

Mudiope³

et al. 2013

Af Hlth Sci

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Background: Access to pediatric antiretroviral formulations is increasing in resource-limited countries, however adult FDCs are still commonly used by antiretroviral therapy (ART) programs. Objective: To describe long-term effectiveness of using adult FDC of d4T+3TC+NVP (Triomune) in children for HIV treatment. Methods: Clinical, immunologic, and virologic outcomes of HIV-infected ART-naïve children aged six months to 12 years, were evaluated up to 96 weeks post-ART initiation. Results: From March 2004 to June 2006, 104 children were followed with a median age of 5.4 years, median CD4 cell percent and HIV-1 RNA were 11.0% (IQR 6.7-13.9) and 348,846copies/mL (IQR 160,941-681,313) respectively at baseline. Using Kaplan-Meir estimates, 75% of children had undetectable viral loads (<400copies/mL) at 96weeks of ART. Children with a baseline CD4 cell percent >15% were 3 times more likely to achieve viral load <400copies/mL than those with baseline CD4 cell percent <5% after adjusting for baseline age {aHR = 3.03 (1.10-8.32), p=0.03}; no difference was found among those with CD4 cell percent >5-14.9% and <5%. Conclusion: Treatment with generic adult FDC for HIV-infected Ugandan children led to sustained clinical, immunologic and virologic response during 96 weeks of ART. Early initiation of ART is key to achieving virological success.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 84%

The long-term effectiveness of generic adult fixed-dose combination antiretroviral therapy for HIV-infected Ugandan children

Barlow-Mosha¹,

Bagenda²,

Mudiope³

et al. 2013

Af Hlth Sci

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“…21–24 Our results extend these finding by assessing the one year outcomes in infants participating in a PMTCT-linked EID program. While the 20% mortality rate we observed in the first year of life among infants diagnosed with HIV at a median age of 7 weeks (IQR 6–8) is an improvement compared to the pre-ART era, it is much higher than the mortality observed in infants randomized to immediate ART in the CHER study (4% over a median follow-up of the full cohort of 40 weeks) conducted in South Africa.…”

Section: Discussionsupporting

confidence: 71%

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

Sheahan

Feinstein

Dube

et al. 2017

Pediatric Infectious Disease Journal

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Background Based on clinical trial results, the WHO recommends infant HIV testing at age 4–6 weeks and immediate antiretroviral therapy (ART) initiation in all HIV-infected infants. Little is known about the outcomes of HIV infected infants diagnosed with HIV in the first weeks of life in resource-limited settings. We assessed ART initiation and mortality in the first year of life among infants diagnosed with HIV by 12 weeks of age. Methods Cohort of HIV-infected infants in Kinshasa and Blantyre diagnosed before 12 weeks to estimate 12-month cumulative incidences of ART initiation and mortality, accounting for competing risks. Multivariate models were used to estimate associations between infant characteristics and timing of ART initiation. Results 121 infants were diagnosed at a median age of 7 weeks (interquartile range 6–8). The cumulative incidence of ART initiation was 46% (95% CI: 36%, 55%) at 6 months and 70% (95% CI: 60%, 78%) at 12 months. Only age at HIV diagnosis was associated with ART initiation by age 6 months, with a subdistribution hazard ratio of 0.70 (95% CI: 0.52, 0.91) for each week increase in age at DNA PCR test. The 12-month cumulative incidence of mortality was 20% (95% CI: 13%, 28%). Conclusions Despite early diagnosis of HIV, ART initiation was slow and mortality remained high, underscoring the complexity in translating clinical trial findings and WHO guidance into real-life practice. Novel and creative health system interventions will be required to ensure that all HIV infected infants achieve optimal treatment outcomes under routine care settings.

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“…It was estimated that earlier access to ART could have prevented 25% of HIV related death [8,9]. However, access to ART for children was only 12% among children under 15 years of age [1].…”

Section: Introductionmentioning

confidence: 99%

Incidence and Predictors of Mortality among Children on Anti-Retroviral Therapy in Public Health Facilities of Arba Minch Town, Gamo Gofa Zone, Southern Ethiopia; Retrospective Cohort Study

Boti¹,

Debere²,

Enderis³

et al. 2017

Clinics Mother Child Health

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Long‐Term Survival of HIV‐Infected Children Receiving Antiretroviral Therapy in Thailand: A 5‐Year Observational Cohort Study

Cited by 57 publications

References 29 publications

The long-term effectiveness of generic adult fixed-dose combination antiretroviral therapy for HIV-infected Ugandan children

The long-term effectiveness of generic adult fixed-dose combination antiretroviral therapy for HIV-infected Ugandan children

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

Incidence and Predictors of Mortality among Children on Anti-Retroviral Therapy in Public Health Facilities of Arba Minch Town, Gamo Gofa Zone, Southern Ethiopia; Retrospective Cohort Study

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