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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Early mortality and loss to follow-up in HIV-infected children starting antiretroviral therapy in Southern Africa
Journal of Acquired Immune Deficiency Syndromes, Volume 54, No. 5, Year 2010
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Description
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 ≥120 months with <18 months], CD4 cell percent (HR: 0.56; 95% CI: 0.39 to 0.78 comparing ≥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. © 2010 by Lippincott Williams & Wilkins.
Authors & Co-Authors
Fenner, Lukas
Switzerland, Bern
University of Bern
Brinkhof, Martin W.G.
Switzerland, Bern
University of Bern
Keiser, Olivia
Switzerland, Bern
University of Bern
Weigel, Ralf
Malawi, Lilongwe
Lighthouse Trust
Cornell, M.
South Africa, Cape Town
University of Cape Town
South Africa, Johannesburg
University of the Witwatersrand
Moultrie, Harry
South Africa, Johannesburg
Chris Hani Baragwanath Hospital
Prozesky, Hans (Hw)
South Africa, Tygerberg
Tygerberg Hospital
Technau, Karl Günter
South Africa, Johannesburg
University of the Witwatersrand
Eley, Brian S.
South Africa, Cape Town
University of Cape Town
Vaz, Paula
Mozambique, Maputo
Paediatric day Hospital
Pascoe, Margaret J.
Zimbabwe, Harare
Newlands Clinic
Giddy, Janet
South Africa, Durban
Mccord Hospital
Van Cutsem, Gilles
South Africa, Johannesburg
University of the Witwatersrand
South Africa, Cape Town
University of Cape Town
Wood, Robin Y.
South Africa, Cape Town
University of Cape Town
Egger, Matthias
Switzerland, Bern
University of Bern
Davies, M. A.
South Africa, Cape Town
University of Cape Town
Statistics
Citations: 111
Authors: 16
Affiliations: 9
Identifiers
Doi:
10.1097/QAI.0b013e3181e0c4cf
ISSN:
15254135
Research Areas
Environmental
Infectious Diseases
Maternal And Child Health
Study Design
Cohort Study
Study Locations
Malawi
Mozambique
South Africa
Zimbabwe