Immunodeficiency in children starting antiretroviral therapy in low-, middle-, and high-income countries

Manuel Koller, Kunjal Patel, Benjamin C. Chi, Kara Wools-Kaloustian, Fatoumata Dicko, Kulkanya Chokephaibulkit, Cleophas Chimbetete, Dorita Avila, Rohan Hazra, Samual Ayaya, Valeriane Leroy, Huu Khanh Truong, Matthias Egger, Mary Ann Davies

Research output: Contribution to journalArticle

28 Citations (Scopus)

Abstract

Background: The CD4 cell count or percent (CD4%) at the start of combination antiretroviral therapy (cART) is an important prognostic factor in children starting therapy and an important indicator of program performance. We describe trends and determinants of CD4 measures at cART initiation in children from low-, middle-, and high-income countries. Methods: We included children aged ,16 years from clinics participating in a collaborative study spanning sub-Saharan Africa, Asia, Latin America, and the United States. Missing CD4 values at cART start were estimated through multiple imputation. Severe immunodeficiency was defined according to World Health Organization criteria. Analyses used generalized additive mixed models adjusted for age, country, and calendar year. Results: A total of 34,706 children from 9 low-income, 6 lower middle-income, 4 upper middle-income countries, and 1 high-income country (United States) were included; 20,624 children (59%) had severe immunodeficiency. In low-income countries, the estimated prevalence of children starting cART with severe immunodeficiency declined from 76% in 2004 to 63% in 2010. Corresponding figures for lower middle-income countries were from 77% to 66% and for upper middle-income countries from 75% to 58%. In the United States, the percentage decreased from 42% to 19% during the period 1996 to 2006. In low-and middle-income countries, infants and children aged 12-15 years had the highest prevalence of severe immunodeficiency at cART initiation. Conclusions: Despite progress in most low-and middle-income countries, many children continue to start cART with severe immunodeficiency. Early diagnosis and treatment of HIV-infected children to prevent morbidity and mortality associated with immunodeficiency must remain a global public health priority..

Original languageEnglish
Pages (from-to)62-72
Number of pages11
JournalJournal of Acquired Immune Deficiency Syndromes
Volume68
Issue number1
StatePublished - Jan 1 2015

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Therapeutics
Health Priorities
Latin America
Africa South of the Sahara
CD4 Lymphocyte Count
Early Diagnosis
Public Health
HIV
Morbidity
Mortality
Global Health

Keywords

  • Antiretroviral
  • CD4
  • Children
  • Global
  • Immunodeficiency

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)

Cite this

Immunodeficiency in children starting antiretroviral therapy in low-, middle-, and high-income countries. / Koller, Manuel; Patel, Kunjal; Chi, Benjamin C.; Wools-Kaloustian, Kara; Dicko, Fatoumata; Chokephaibulkit, Kulkanya; Chimbetete, Cleophas; Avila, Dorita; Hazra, Rohan; Ayaya, Samual; Leroy, Valeriane; Truong, Huu Khanh; Egger, Matthias; Davies, Mary Ann.

In: Journal of Acquired Immune Deficiency Syndromes, Vol. 68, No. 1, 01.01.2015, p. 62-72.

Research output: Contribution to journalArticle

Koller, M, Patel, K, Chi, BC, Wools-Kaloustian, K, Dicko, F, Chokephaibulkit, K, Chimbetete, C, Avila, D, Hazra, R, Ayaya, S, Leroy, V, Truong, HK, Egger, M & Davies, MA 2015, 'Immunodeficiency in children starting antiretroviral therapy in low-, middle-, and high-income countries', Journal of Acquired Immune Deficiency Syndromes, vol. 68, no. 1, pp. 62-72.
Koller, Manuel ; Patel, Kunjal ; Chi, Benjamin C. ; Wools-Kaloustian, Kara ; Dicko, Fatoumata ; Chokephaibulkit, Kulkanya ; Chimbetete, Cleophas ; Avila, Dorita ; Hazra, Rohan ; Ayaya, Samual ; Leroy, Valeriane ; Truong, Huu Khanh ; Egger, Matthias ; Davies, Mary Ann. / Immunodeficiency in children starting antiretroviral therapy in low-, middle-, and high-income countries. In: Journal of Acquired Immune Deficiency Syndromes. 2015 ; Vol. 68, No. 1. pp. 62-72.
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abstract = "Background: The CD4 cell count or percent (CD4{\%}) at the start of combination antiretroviral therapy (cART) is an important prognostic factor in children starting therapy and an important indicator of program performance. We describe trends and determinants of CD4 measures at cART initiation in children from low-, middle-, and high-income countries. Methods: We included children aged ,16 years from clinics participating in a collaborative study spanning sub-Saharan Africa, Asia, Latin America, and the United States. Missing CD4 values at cART start were estimated through multiple imputation. Severe immunodeficiency was defined according to World Health Organization criteria. Analyses used generalized additive mixed models adjusted for age, country, and calendar year. Results: A total of 34,706 children from 9 low-income, 6 lower middle-income, 4 upper middle-income countries, and 1 high-income country (United States) were included; 20,624 children (59{\%}) had severe immunodeficiency. In low-income countries, the estimated prevalence of children starting cART with severe immunodeficiency declined from 76{\%} in 2004 to 63{\%} in 2010. Corresponding figures for lower middle-income countries were from 77{\%} to 66{\%} and for upper middle-income countries from 75{\%} to 58{\%}. In the United States, the percentage decreased from 42{\%} to 19{\%} during the period 1996 to 2006. In low-and middle-income countries, infants and children aged 12-15 years had the highest prevalence of severe immunodeficiency at cART initiation. Conclusions: Despite progress in most low-and middle-income countries, many children continue to start cART with severe immunodeficiency. Early diagnosis and treatment of HIV-infected children to prevent morbidity and mortality associated with immunodeficiency must remain a global public health priority..",
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AU - Koller, Manuel

AU - Patel, Kunjal

AU - Chi, Benjamin C.

AU - Wools-Kaloustian, Kara

AU - Dicko, Fatoumata

AU - Chokephaibulkit, Kulkanya

AU - Chimbetete, Cleophas

AU - Avila, Dorita

AU - Hazra, Rohan

AU - Ayaya, Samual

AU - Leroy, Valeriane

AU - Truong, Huu Khanh

AU - Egger, Matthias

AU - Davies, Mary Ann

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N2 - Background: The CD4 cell count or percent (CD4%) at the start of combination antiretroviral therapy (cART) is an important prognostic factor in children starting therapy and an important indicator of program performance. We describe trends and determinants of CD4 measures at cART initiation in children from low-, middle-, and high-income countries. Methods: We included children aged ,16 years from clinics participating in a collaborative study spanning sub-Saharan Africa, Asia, Latin America, and the United States. Missing CD4 values at cART start were estimated through multiple imputation. Severe immunodeficiency was defined according to World Health Organization criteria. Analyses used generalized additive mixed models adjusted for age, country, and calendar year. Results: A total of 34,706 children from 9 low-income, 6 lower middle-income, 4 upper middle-income countries, and 1 high-income country (United States) were included; 20,624 children (59%) had severe immunodeficiency. In low-income countries, the estimated prevalence of children starting cART with severe immunodeficiency declined from 76% in 2004 to 63% in 2010. Corresponding figures for lower middle-income countries were from 77% to 66% and for upper middle-income countries from 75% to 58%. In the United States, the percentage decreased from 42% to 19% during the period 1996 to 2006. In low-and middle-income countries, infants and children aged 12-15 years had the highest prevalence of severe immunodeficiency at cART initiation. Conclusions: Despite progress in most low-and middle-income countries, many children continue to start cART with severe immunodeficiency. Early diagnosis and treatment of HIV-infected children to prevent morbidity and mortality associated with immunodeficiency must remain a global public health priority..

AB - Background: The CD4 cell count or percent (CD4%) at the start of combination antiretroviral therapy (cART) is an important prognostic factor in children starting therapy and an important indicator of program performance. We describe trends and determinants of CD4 measures at cART initiation in children from low-, middle-, and high-income countries. Methods: We included children aged ,16 years from clinics participating in a collaborative study spanning sub-Saharan Africa, Asia, Latin America, and the United States. Missing CD4 values at cART start were estimated through multiple imputation. Severe immunodeficiency was defined according to World Health Organization criteria. Analyses used generalized additive mixed models adjusted for age, country, and calendar year. Results: A total of 34,706 children from 9 low-income, 6 lower middle-income, 4 upper middle-income countries, and 1 high-income country (United States) were included; 20,624 children (59%) had severe immunodeficiency. In low-income countries, the estimated prevalence of children starting cART with severe immunodeficiency declined from 76% in 2004 to 63% in 2010. Corresponding figures for lower middle-income countries were from 77% to 66% and for upper middle-income countries from 75% to 58%. In the United States, the percentage decreased from 42% to 19% during the period 1996 to 2006. In low-and middle-income countries, infants and children aged 12-15 years had the highest prevalence of severe immunodeficiency at cART initiation. Conclusions: Despite progress in most low-and middle-income countries, many children continue to start cART with severe immunodeficiency. Early diagnosis and treatment of HIV-infected children to prevent morbidity and mortality associated with immunodeficiency must remain a global public health priority..

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