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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Low risk of death, but substantial program attrition, in pediatric HIV treatment cohorts in sub-saharan Africa
Journal of Acquired Immune Deficiency Syndromes, Volume 49, No. 5, Year 2008
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Description
Background: To date, an estimated 10% of children eligible for antiretroviral treatment (ART) receive it, and the frequency of retention in programs is unknown. We evaluated the 2-year risks of death and loss to follow-up (LTFU) of children after ART initiation in a multicenter study in sub-Saharan Africa. Methods: Pooled analysis of routine individual data from 16 participating clinics produced overall Kaplan-Meier estimates of the probabilities of death or LTFU after ART initiation. Risk factors analysis used Weibull regression, accounting for between-cohort heterogeneity. Results: The median age of 2405 children at ART initiation was 4.9 years (12%, younger than 12 months), 52% were male, 70% had severe immunodeficiency, and 59% started ART with a nonnucleoside reverse transcriptase inhibitor. The 2-year risk of death after ART initiation was 6.9% (95% confidence interval [CI]: 5.9 to 8.1), independently associated with baseline severe anemia (adjusted hazard ratio [aHR]: 4.10 [CI: 2.36 to 7.13]), immunodeficiency (adjusted aHR: 2.95 [CI: 1.49 to 5.82]), and severe clinical status (adjusted aHR: 3.64 [CI: 1.95 to 6.81]); the 2-year risk of LTFU was 10.3% (CI: 8.9 to 11.9), higher in children with severe clinical status. Conclusions: Once on treatment, the 2-year risk of death is low but the LTFU risk is substantial. ART is still mainly initiated at advanced disease stage in African children, reinforcing the need for early HIV diagnosis, early initiation of ART, and procedures to increase program retention. Copyright © 2008 Lippincott Williams & Wilkins.
Authors & Co-Authors
Dabis, Franćois Ç.Ois
France, Paris
Inserm
Benin, Cotonou
Hôpital D'instruction Des Armées de Cotonou
Mbori-Ngacha, Dorothy A.
Benin, Cotonou
Hôpital D'instruction Des Armées de Cotonou
Arrivé, Élise
Benin, Cotonou
Hôpital D'instruction Des Armées de Cotonou
Kyabayinze, Daniel J.
Benin, Cotonou
Hôpital D'instruction Des Armées de Cotonou
Marquis, Benoit
Benin, Cotonou
Hôpital D'instruction Des Armées de Cotonou
Namale, Leticia
Benin, Cotonou
Hôpital D'instruction Des Armées de Cotonou
Olet, Susan
Benin, Cotonou
Hôpital D'instruction Des Armées de Cotonou
Tumwesigye, Nazarius Mbona
Benin, Cotonou
Hôpital D'instruction Des Armées de Cotonou
Azondékon, Alain
Benin, Cotonou
Hôpital D'instruction Des Armées de Cotonou
Kaboré, Alice Zougrana
Burkina Faso, Ouagadougou
Hopital Général de Gaulle
Boulle, Andrew
South Africa, Cape Town
Khayelitsha Hospital
Coetzee, David John
South Africa, Cape Town
Khayelitsha Hospital
Violari, Avy
South Africa, Johannesburg
Chris Hani Baragwanath Hospital
Jokhan, Rikash
South Africa, Johannesburg
Chris Hani Baragwanath Hospital
Ondoa-Onama, Christine
Uganda
Arua Regional Referral Hospital
Abrams, Elain
United States
Rosalid Carter
Sunioh, Frida
Cameroon
Provincial Hospital
Sy, Haby Signaté
Senegal, Dakar
Hopital D'enfants Albert-royer Dakar
Ndiaye, Fatou Ly
Senegal, Dakar
Hopital D'enfants Albert-royer Dakar
Massawe, Higgins P.
Tanzania, Dar es Salaam
Muhimbili National Hospital
Massawe, Augustin
Tanzania, Dar es Salaam
Muhimbili National Hospital
Kiwanuka, Julius P.
Uganda, Mbarara
Mbarara University of Science and Technology
Chipepo, Kankasa
Zambia, Lusaka
University Teaching Hospital Lusaka
Mwiya, Mwiya
Zambia, Lusaka
University Teaching Hospital Lusaka
A Renner, Lorna
Ghana, Accra
Korle bu Hospital
Goka, Bamenla Quarm
Ghana, Accra
Korle bu Hospital
Wemin, Louise
Cote D'ivoire, Abidjan
Cepref Enfants
Pascoe, Margaret J.
Zimbabwe, Harare
Connaught Clinic
Nanyonga, Maria
Uganda, Kampala
Nsambya Hospital
Sylla, Mariam Moustapha
Mali, Bamako
Hopital Gabriel Toure
Dicko-Traoré, Fatoumata B.
Mali, Bamako
Hopital Gabriel Toure
Uwurukundo, Marie Claude
Rwanda
Chu Butare
Cotton, Mark Fredric
South Africa, Tygerberg
Tygerberg Hospital
Rabie, Helena
South Africa, Tygerberg
Tygerberg Hospital
Prozesky, Hans (Hw)
South Africa, Tygerberg
Tygerberg Hospital
Edson, Clair
South Africa, Tygerberg
Tygerberg Hospital
Weber, Heinrich
South Africa, Tygerberg
Tygerberg Hospital
Madide, A.
South Africa, Tygerberg
Tygerberg Hospital
Paterson, Mark
Zimbabwe
Provincial Hospital of Mutare
Muganga, Narcisse
Rwanda, Kigali
Chu de Kigali
Fassinou, Patricia
Cote D'ivoire, Abidjan
Centre Hospitalier Universitaire de Treichville
Nimbona, Pélagie
Burundi
Association Nationale de Soutien Aux Séropositifs Anss
Kariyo, Pierre Claver
Burundi
University of Kamenge
Weigel, Ralf
Malawi, Lilongwe
Lighthouse Trust
Jones, Sarah Rowland
Gambia, Banjul
Medical Research Council Laboratories Gambia
Aveika, Akum Akum
Gambia, Banjul
Medical Research Council Laboratories Gambia
Meade, Timothy
Zambia, Lusaka
Corpmed Clinic
Luo, Chewe
South Africa
United Nations Children's Fund
Abrams, Elaine J.
United States, New York
Columbia University
Newell, Marie Louise
South Africa, Ghent
Africa Center
Kieffer, Mary Pat
Unknown Affiliation
Egger, Matthias
Switzerland, Bern
University of Bern
Miotti, Paolo G.
United States, Bethesda
National Institutes of Health Nih
Nduati, Ruth W.
Unknown Affiliation
Leroy, Valeriane
France, Bordeaux
Isped Bordeaux
Statistics
Citations: 90
Authors: 55
Affiliations: 33
Identifiers
Doi:
10.1097/QAI.0b013e31818aadce
ISSN:
15254135
Research Areas
Environmental
Genetics And Genomics
Infectious Diseases
Maternal And Child Health
Study Design
Cohort Study
Participants Gender
Male