Outcomes of antiretroviral therapy in children in Asia and Africa: A comparative analysis of the IeDEA pediatric multiregional collaboration

Valeriane Leroy, Karen Malateste, Helena Rabie, Pagakrong Lumbiganon, Samuel Ayaya, Fatoumata Dicko, Mary Ann Davies, Azar Kariminia, Kara Wools-Kaloustian, Edmond Aka, Samuel Phiri, Linda Aurpibul, Constantin Yiannoutsos, Haby Signaté-Sy, Lynne Mofenson, François Dabis

Research output: Contribution to journalArticle

52 Scopus citations

Abstract

BACKGROUND: We investigated 18-month incidence and determinants of death and loss to follow-up of children after antiretroviral therapy (ART) initiation in a multiregional collaboration in lower-income countries. METHODS: HIV-infected children (positive polymerase chain reaction <18 months or positive serology ≥18 months) from International Epidemiologic Databases to Evaluate AIDS cohorts, <16 years, initiating ART were eligible. A competing risk regression model was used to analyze the independent risk of 2 failure types: death and loss to follow-up (>6 months). FINDINGS: Data on 13,611 children, from Asia (N = 1454), East Africa (N = 3114), Southern Africa (N = 6212), and West Africa (N = 2881) contributed 20,417 person-years of follow-up. At 18 months, the adjusted risk of death was 4.3% in East Africa, 5.4% in Asia, 5.7% in Southern Africa, and 7.4% in West Africa (P = 0.01). Age < 24 months, World Health Organization stage 4, CD4 < 10%, attending a private sector clinic, larger cohort size, and living in West Africa were independently associated with poorer survival. The adjusted risk of loss to follow-up was 4.1% in Asia, 9.0% in Southern Africa, 14.0% in East Africa, and 21.8% in West Africa (P < 0.01). Age < 12 months, nonnucleoside reverse transcriptase inhibitor I-based ART regimen, World Health Organization stage 4 at ART start, ART initiation after 2005, attending a public sector or a nonurban clinic, having to pay for laboratory tests or antiretroviral drugs, larger cohort size, and living in East Africa or West Africa were significantly associated with higher loss to follow-up. CONCLUSIONS: Findings differed substantially across regions but raise overall concerns about delayed ART start, low access to free HIV services for children, and increased workload on program retention in lower-income countries. Universal free access to ART services and innovative approaches are urgently needed to improve pediatric outcomes at the program level.

Original languageEnglish (US)
Pages (from-to)208-219
Number of pages12
JournalJournal of Acquired Immune Deficiency Syndromes
Volume62
Issue number2
DOIs
StatePublished - Feb 1 2013

Keywords

  • Africa
  • antiretroviral therapy
  • Asia
  • children
  • cohort studies
  • HIV infection
  • loss to follow-up
  • low-income countries
  • mortality

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)

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    Leroy, V., Malateste, K., Rabie, H., Lumbiganon, P., Ayaya, S., Dicko, F., Davies, M. A., Kariminia, A., Wools-Kaloustian, K., Aka, E., Phiri, S., Aurpibul, L., Yiannoutsos, C., Signaté-Sy, H., Mofenson, L., & Dabis, F. (2013). Outcomes of antiretroviral therapy in children in Asia and Africa: A comparative analysis of the IeDEA pediatric multiregional collaboration. Journal of Acquired Immune Deficiency Syndromes, 62(2), 208-219. https://doi.org/10.1097/QAI.0b013e31827b70bf