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Home >> Publications >> Incidence of WHO Stage 3 and 4 Events, Tuberculosis, and Mortality in Untreated, HIV-Infected Children Enrolling in Care Before 1 Year of Age: An Iedea (International Epidemiologic Databases To Evaluate AIDS) East Africa Regional Analysis.

Publication

Author(s):

Ciaranello A, Lu Z, Ayaya S, Losina E, Musick B, Vreeman R, Freedberg KA, Abrams EJ, Dillabaugh L, Doherty K, Ssali J, Yiannoutsos CT, Wools-Kaloustian K.

Pub Title:

Incidence of WHO Stage 3 and 4 Events, Tuberculosis, and Mortality in Untreated, HIV-Infected Children Enrolling in Care Before 1 Year of Age: An Iedea (International Epidemiologic Databases To Evaluate AIDS) East Africa Regional Analysis.

Pub Date:

Jun 30 2014

Pub Region(s):

East Africa

Journal:

Title: 
Pediatr Infect Dis J
Link: 
http://journals.lww.com/pidj/pages/articleviewer.aspx?year=9000&issue=00000&article=98113&type=abstract

PubMed: 24378935
Pub PDF:

Abstract
BACKGROUND: Few studies have reported CD4%- and age-stratified rates of WHO Stage 3 (WHO3) events, WHO Stage 4 (WHO4) events, tuberculosis (TB), and mortality in HIV-infected infants before initiation of antiretroviral therapy (ART).

METHODS: HIV-infected children enrolled before 1 year of age in the International Epidemiologic Databases to Evaluate AIDS (IeDEA) East Africa region (10/01/2002-11/30/2008) were included. We estimated incidence rates of earliest clinical event (WHO3, WHO4, and TB), prior to ART initiation per local guidelines, stratified by current age (< or ≥6 months) and current CD4% (<15%, 15-24%, ≥25%). CD4%-stratified mortality rates were estimated separately for children who did not experience a clinical event ("background" mortality) and for children who experienced an event, including 'acute' mortality (≤30 days post-event) and "later" mortality (>30 days post-event).

RESULTS: Among 847 children (median enrollment age: 4.8 months; median pre-ART follow-up: 10.8 months; 603 (71%) with ≥1 CD4% recorded), event rates were comparable for those aged <6 and ≥6 months. Current CD4% was associated with risk of WHO4 events for children <6 months old, and with all evaluated events for children ≥6 months old (p<0.05). "Background" mortality was 3.7-8.4/100py. 'Acute" mortality (≤30 days post-event) was 33.8/100py (after TB) and 41.1/100py (after WHO3 or WHO4). "Later" mortality (>30 days post-event) ranged by CD4% from 4.7-29.1/100py.

CONCLUSIONS: In treatment-naïve, HIV-infected infants, WHO3, WHO4, and TB events were common before and after 6 months of age and led to substantial increases in mortality. Early infant HIV diagnosis and treatment are critically important, regardless of CD4%.

 

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Citation:

Ciaranello A, Lu Z, Ayaya S, Losina E, Musick B, Vreeman R, Freedberg KA, Abrams EJ, Dillabaugh L, Doherty K, Ssali J, Yiannoutsos CT, Wools-Kaloustian K. Incidence of WHO Stage 3 and 4 Events, Tuberculosis, and Mortality in Untreated, HIV-Infected Children Enrolling in Care Before 1 Year of Age: An Iedea (International Epidemiologic Databases To Evaluate AIDS) East Africa Regional Analysis. Pediatr Infect Dis J. 2013 Dec 30. [Epub ahead of print] PubMed PMID: 24378935.