The impact of highly active antiretroviral therapy on the survival of vertically HIV-infected children and adolescents in Belo Horizonte, Brazil

Cardoso, Claudete Aparecida Araújo; Pinto, Jorge; Candiani, Talitah Michel Sanchez; Carvalho, Inácio R.; Linhares, Renato Moreira; Goulart, Eugênio Marcos Andrade

doi:10.1590/s0074-02762012000400014

Cited by 14 publications

(22 citation statements)

References 34 publications

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“…The accumulated mortality rate was almost 15% for this cohort over the 11-year period of evaluation at a state referral hospital in Vitória, Espírito Santo, Brazil. This rate is higher than that found in a cohort of 320 children and adolescents in Belo Horizonte, Minas Gerais, Brazil (9.7%) and also higher than the rate of 12.1% reported in a study on the impact of HAART, opportunistic infections, hospitalizations and mortality in 371 children and adolescents in Belo Horizonte [ 8 , 9 ]. Nevertheless, this rate was lower than that of 26.9% found in the US Perinatal AIDS Collaborative Transmission Study (1986–2004) [ 4 ].…”

Section: Discussioncontrasting

confidence: 62%

“…On the contrary, in the present study, the principal grouped cause of death was severe bacterial infections, probably due to the differences between industrialized countries and resource-limited countries. As also reported in the study from Belo Horizonte, the two principal causes of death were pneumonia and sepsis [ 8 ]. In a cohort study conducted with 586 HIV-infected children in Thailand who initiated use of antiretroviral therapy, all the 42 deaths that occurred were attributed to infection [ 25 ].…”

Section: Discussionsupporting

confidence: 54%

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Mortality in children and adolescents vertically infected by HIV receiving care at a referral hospital in Vitoria, Brazil

2015

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BackgroundDaily throughout 2011, about 900 new HIV infections occurred in children and 630 children died as a result of AIDS-related complications worldwide. Late diagnosis, mortality trends, causes of and risk factors for death were evaluated in vertically HIV-infected children.MethodsA retrospective 11-year study was conducted with Brazilian vertically HIV-infected children and adolescents using patients’ charts. Medical records, death certificates and the Ministry of Health’s mortality database were verified for mortality and cause of death. Diagnoses were made according to the CDC Revised Classification System for HIV infection.ResultsOf 177 patients included, 97 were female (54.8%). Median age at admission was 30 months (IQR: 5–72 months). Median follow-up was 5 years (IQR: 2–8 years). After 11 years, 132 (74,6%) patients continued in follow-up, 11 (6.2%) had been transferred and 8 (4.5%) were lost to follow-up. Twenty-six deaths occurred (14,7%), the majority (16/26; 61.5%) in children <3 years of age. Death cases decreased over time and the distribution of deaths was homogenous over the years of evaluation. In 17/26 (65.4%) of the children who died, diagnosis had been made as the result of their becoming ill. Beginning antiretroviral therapy before 6 months of age was associated with being alive (OR = 2.86; 95% CI: 1.12–7.25; p = 0.027). The principal causes of death were severe bacterial infections (57%) and opportunistic infections (33.3%).ConclusionsIn most of the HIV-infected children, diagnosis was late, increasing the risk of progression to AIDS and death due to delayed treatment. The mortality trend was constant, decreasing in the final two years of the study. Bacterial infections remain as the major cause of death. Improvements in prenatal care and pediatric monitoring are mandatory.

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Section: Discussioncontrasting

confidence: 62%

Section: Discussionsupporting

confidence: 54%

Mortality in children and adolescents vertically infected by HIV receiving care at a referral hospital in Vitoria, Brazil

2015

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“…Antiretroviral therapy (ART) becomes increasingly available globally in the world, not in all the low incomes countries. The impact of highly active antiretroviral therapy on HIV infected children survival becomes evident [20]. In the context of delay to ART initiation for children admitted in feeding therapeutic centers or in rural facilities.…”

Section: Discussionmentioning

confidence: 99%

Impact of HIV/AIDS on mortality and nutritional recovery among hospitalized severely malnourished children before starting antiretroviral treatment

Savadogo¹,

Donnen²,

Kouéta³

et al. 2013

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In low income countries, severe acute malnutrition remains a major problem for HIV-infected children and an important risk factor for mortality. This study aims to analyze HIV impact on mortality rate and nutritional recovery among severely malnourished HIV/AIDS uninfected and infected children. This was a retrospective cohort study conducted from data of 521 hospitalized severely malnourished children. We used Pearson's Chi square test to compare proportions; and Student's independent t-test to compare means; general linear model to analyze repeated measurements. We used mortality relative risk with confidence interval (CI 95%), Kaplan-Meir survival curves and Cox proportional hazard models to analyze the HIV impact on mortality rate. Case fatality rate differed significantly from SAM HIV uninfected (10.7%) and HIV infected children (39.7%), p < 0.001. Mortality relative risk was 3.71, 95% IC [2.51-5.47] for HIV infected children. Kaplan-Meir survival curves differed significantly between the two groups, (p Log Rank < 0.001). Cox regression adjusted mortality relative risk of HIV infected children was 4.27, CI: 2.55-7.15, p < 0.001. Mean weight gain differed significantly among infected children, p < 0.001. Anthropometric Z-scores means evolution differed significantly between HIV infected and uninfected children and within each group's subjects for WHZ (p < 0.001) and WAZ (p < 0.001). Mortality relative risk was 3.71 times higher for HIV infected children. Multiples infections and metabolic complications have synergism on death occurrence in sever acute malnutrition; when associated to HIV infection, case fatality rate increases many times. Weight gain and anthropometrics index evolution were very slow for SAM HIV infected children, and specific diet may be needed for more nutritional recovery. Effective interventions, updated and adapting to local country context, to improve survival of severely malnourished HIV/AIDS infected children in HIV and SAM prevalent settings are urgently needed in the area of SAM's community-based treatment approach.

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“…Em uma análise de sobrevida de uma coorte de 359 crianças infectadas por transmissão vertical do HIV em Belo Horizonte (Minas Gerais), introdução da TARVC foi fator protetor e má nutrição foi fator de risco para o óbito 17 . Em 2007, esse mesmo grupo de pesquisadores demonstrou que as taxas de infecções oportunistas reduziram de 18,3 para 2,6 infecções por 100 pessoas por ano, comparando-se as eras pré-e pós-TARVC, respectivamente 62 .…”

Section: Década De 1990: Avanço No Conhecimento Da Doença E Tentativaunclassified

“…Um novo marco na evolução da epidemia ocorreu por intermédio da introdução da TARVC, uma combinação de pelo menos três drogas antirretrovirais ativas contra o HIV 10 . Constatou-se, então, uma "cronificação da epidemia" com aumento da sobrevida dos pacientes submetidos à TARVC 10,11,12,13,14,15,16,17,18 . O impacto dessa nova abordagem na sobrevida dos pacientes pediátricos desencadeou importantes mudanças nos centros de atendimento especializado, com redimensionamento das diretrizes do tratamento, visando ao acesso e à adesão à terapia proposta 18,19,20 .…”

Section: Introductionunclassified

Terapia antirretroviral em crianças e adolescentes infectados pelo HIV: o que sabemos após 30 anos de epidemia

et al. 2014

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Este estudo tem como objetivo avaliar o uso da terapia antirretroviral combinada em crianças e adolescentes com AIDS. Foram captados 247 resumos nos portais PubMed e LILACS, publicados entre 1983 e 2013, sendo utilizados 69 artigos para as referências bibliográficas. A atenção atribuída às pesquisas na faixa etária pediátrica durante os trinta anos de epidemia de AIDS se justifica por características imunológicas próprias, sendo a progressão da AIDS mais rápida em crianças que em adultos. Pesquisas recentes abordam estratégias de intervenção medicamentosa de alta potência antes do aparecimento dos sintomas iniciais. A introdução precoce da terapia antirretroviral combinada foi implantada com eficácia e segurança em populações com poucos recursos fixos, com melhora significativa da sobrevida desses pacientes. O desafio atual é lidar com uma doença crônica com intercorrências agudas. Novas pesquisas serão necessárias, atentando para as especificidades populacionais e particularizando as necessidades individuais dos pacientes pediátricos.

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The impact of highly active antiretroviral therapy on the survival of vertically HIV-infected children and adolescents in Belo Horizonte, Brazil

Cited by 14 publications

References 34 publications

Mortality in children and adolescents vertically infected by HIV receiving care at a referral hospital in Vitoria, Brazil

Mortality in children and adolescents vertically infected by HIV receiving care at a referral hospital in Vitoria, Brazil

Impact of HIV/AIDS on mortality and nutritional recovery among hospitalized severely malnourished children before starting antiretroviral treatment

Terapia antirretroviral em crianças e adolescentes infectados pelo HIV: o que sabemos após 30 anos de epidemia

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