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Home >> Publications >> Optimal timing of antiretroviral treatment initiation in HIV-positive children and adolescents: a multiregional analysis from Southern Africa, West Africa and Europe.

Publication

Author(s):

Schomaker M1, Leroy V2, Wolfs T3, Technau KG4, Renner L5, Judd A6, Sawry S7, Amorissani-Folquet M8, Noguera-Julian A9, Tanser F10, Eboua F11, Navarro ML12, Chimbetete C13, Amani-Bosse C14, Warszawski J15, Phiri S16, N'Gbeche S17, Cox V18, Koueta F19, Giddy J20, Sygnaté-Sy H21, Raben D22, Chêne G23, Davies MA24; IeDEA West and Southern Africa regional collaborations and COHERE in EuroCoord.

Pub Title:

Optimal timing of antiretroviral treatment initiation in HIV-positive children and adolescents: a multiregional analysis from Southern Africa, West Africa and Europe.

Pub Date:

Jun 24 2016

Pub Region(s):

Multiregional, Southern Africa

Journal:

Title: 
Int J Epidemiol.
Link: 
http://ije.oxfordjournals.org/content/early/2016/06/22/ije.dyw097.long

PubMed: 27342220
Pub PDF:

BACKGROUND: There is limited knowledge about the optimal timing of antiretroviral treatment initiation in older children and adolescents.
METHODS: A total of 20 576 antiretroviral treatment (ART)-naïve patients, aged 1-16 years at enrolment, from 19 cohorts in Europe, Southern Africa and West Africa, were included. We compared mortality and growth outcomes for different ART initiation criteria, aligned with previous and recent World Health Organization criteria, for 5 years of follow-up, adjusting for all measured baseline and time-dependent confounders using the g-formula.
RESULTS: Median (1st;3rd percentile) CD4 count at baseline was 676 cells/mm3 (394; 1037) (children aged ≥ 1 and < 5 years), 373 (172; 630) (≥ 5 and < 10 years) and 238 (88; 425) (≥ 10 and < 16 years). There was a general trend towards lower mortality and better growth with earlier treatment initiation. In children < 10 years old at enrolment, by 5 years of follow-up there was lower mortality and a higher mean height-for-age z-score with immediate ART initiation versus delaying until CD4 count < 350 cells/mm3 (or CD4% < 15% or weight-for-age z-score < -2) with absolute differences in mortality and height-for-age z-score of 0.3% (95% confidence interval: 0.1%; 0.6%) and -0.08 (-0.09; -0.06) (≥ 1 and < 5 years), and 0.3% (0.04%; 0.5%) and -0.07 (-0.08; -0.05) (≥ 5 and < 10 years). In those aged > 10 years at enrolment we did not find any difference in mortality or growth with immediate ART initiation, with estimated differences of -0.1% (-0.2%; 0.6%) and -0.03 (-0.05; 0.00), respectively. Growth differences in children aged < 10 years persisted for treatment thresholds using higher CD4 values. Regular follow-up led to better height and mortality outcomes.
CONCLUSIONS: Immediate ART is associated with lower mortality and better growth for up to 5 years in children < 10 years old. Our results on adolescents were inconclusive.
 

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Citation:

Int J Epidemiol. 2016 Jun 24. pii: dyw097. [Epub ahead of print] Optimal timing of antiretroviral treatment initiation in HIV-positive children and adolescents: a multiregional analysis from Southern Africa, West Africa and Europe. Schomaker M1, Leroy V2, Wolfs T3, Technau KG4, Renner L5, Judd A6, Sawry S7, Amorissani-Folquet M8, Noguera-Julian A9, Tanser F10, Eboua F11, Navarro ML12, Chimbetete C13, Amani-Bosse C14, Warszawski J15, Phiri S16, N'Gbeche S17, Cox V18, Koueta F19, Giddy J20, Sygnaté-Sy H21, Raben D22, Chêne G23, Davies MA24; IeDEA West and Southern Africa regional collaborations and COHERE in EuroCoord.