LOGIN

International Epidemiology Databases to Evaluate AIDS

Home >> Publications >> Early mortality and loss to follow-up in HIV-infected children starting antiretroviral therapy in Southern Africa.

Publication

Author(s):

Fenner L, Brinkhof MW, Keiser O, Weigel R, Cornell M, Moultrie H, Prozesky H, Technau K, Eley B, Vaz P, Pascoe M, Giddy J, Van Cutsem G, Wood R, Egger M, Davies MA; International epidemiologic Databases to Evaluate AIDS in Southern Africa.

Pub Title:

Early mortality and loss to follow-up in HIV-infected children starting antiretroviral therapy in Southern Africa.

Pub Date:

Aug 31 2010

Pub Region(s):

Southern Africa

Journal Issue:

5

Page Number:
524-32

Journal:

Title: 
JAIDS- Journal of Acquired Immune Deficiency Syndromes
Link: 
http://www.ncbi.nlm.nih.gov/pubmed/20588185

PubMed: 20588185
Pub PDF: PDF icon 20588185.pdf

Abstract
BACKGROUND
: Many HIV-infected children in Southern Africa have been started on antiretroviral therapy (ART), but loss to follow up (LTFU) can be substantial. We analyzed mortality in children retained in care and in all children starting ART, taking LTFU into account.

PATIENTS AND METHODS: Children who started ART before the age of 16 years in 10 ART programs in South Africa, Malawi, Mozambique, and Zimbabwe were included. Risk factors for death in the first year of ART were identified in Weibull models. A meta-analytic approach was used to estimate cumulative mortality at 1 year.

RESULTS: Eight thousand two hundred twenty-five children (median age 49 months, median CD4 cell percent 11.6%) were included; 391 (4.8%) died and 523 (7.0%) were LTFU in the first year. Mortality at 1 year was 4.5% [95% confidence interval (CI): 2.8% to 7.4%] in children remaining in care, but 8.7% (5.4% to 12.1%) at the program level, after taking mortality in children and LTFU into account. Factors associated with mortality in children remaining in care included age [adjusted hazard ratio (HR) 0.37; 95% CI: 0.25 to 0.54 comparing > or =120 months with <18 months], CD4 cell percent (HR: 0.56; 95% CI: 0.39 to 0.78 comparing > or =20% with <10%), and clinical stage (HR: 0.12; 95% CI: 0.03 to 0.45 comparing World Health Organization stage I with III/IV).

CONCLUSIONS: In children starting ART and remaining in care in Southern Africa mortality at 1 year is <5% but almost twice as high at the program level, when taking LTFU into account. Age, CD4 percentage, and clinical stage are important predictors of mortality at the individual level.

PMID: 20588185 [PubMed - indexed for MEDLINE]

PMCID: PMC2925143

 

The following websites provide guidelines and policies when citing from PubMed®: http://www.ncbi.nlm.nih.gov/books/NBK7243/
http://www.nlm.nih.gov/bsd/policy/cit_format.html

Citation:

Fenner L, Brinkhof MW, Keiser O, Weigel R, Cornell M, Moultrie H, Prozesky H, Technau K, Eley B, Vaz P, Pascoe M, Giddy J, Van Cutsem G, Wood R, Egger M, Davies MA; International epidemiologic Databases to Evaluate AIDS in Southern Africa. Early mortality and loss to follow-up in HIV-infected children starting antiretroviral therapy in Southern Africa. J Acquir Immune Defic Syndr. 2010 Aug;54(5):524-32. doi: 10.1097/QAI.0b013e3181e0c4cf. PubMed PMID: 20588185; PubMed Central PMCID: PMC2925143.