Please use this identifier to cite or link to this item: http://hdl.handle.net/2445/157097
Title: Long-term trends in mortality and AIDS-defining events after combination ART initiation among children and adolescents with perinatal HIV infection in 17 middle- and high-income countries in Europe and Thailand: A cohort study
Author: Judd, Ali
Chappell, Elizabeth
Turkova, Anna
Le Coeur, Sophie
Noguera Julian, Antoni
Goetghebuer, Tessa
Doerholt, Katja
Galli, Luisa
Pajkrt, Dasja
Marques, Laura
Collins, Intira J.
Gibb, Diana M.
González Tome, Maria Isabel
Navarro, Marisa
Warszawski, Josiane
Königs, Christoph
Spoulou, Vana
Prata, Filipa
Chiappini, Elena
Naver, Lars
Giaquinto, Carlo
Thorne, Claire
Marczynska, Magdalena
Okhonskaia, Liubov
Posfay-Barbe, Klara
Ounchanum, Pradthana
Techakunakorn, Pornchai
Kiseleva, Galina
Malyuta, Ruslan
Volokha, Alla
Ene, Luminita
Goodall, Ruth
Keywords: VIH (Virus)
Mortalitat infantil
HIV (Viruses)
Infant mortality
Issue Date: 30-Jan-2018
Publisher: Public Library of Science (PLoS)
Abstract: Background: Published estimates of mortality and progression to AIDS as children with HIV approach adulthood are limited. We describe rates and risk factors for death and AIDS-defining events in children and adolescents after initiation of combination antiretroviral therapy (cART) in 17 middle- and high-income countries, including some in Western and Central Europe (W&CE), Eastern Europe (Russia and Ukraine), and Thailand. Methods and findings: Children with perinatal HIV aged <18 years initiating cART were followed until their 21st birthday, transfer to adult care, death, loss to follow-up, or last visit up until 31 December 2013. Rates of death and first AIDS-defining events were calculated. Baseline and time-updated risk factors for early/late (≤/>6 months of cART) death and progression to AIDS were assessed. Of 3,526 children included, 32% were from the United Kingdom or Ireland, 30% from elsewhere in W&CE, 18% from Russia or Ukraine, and 20% from Thailand. At cART initiation, median age was 5.2 (IQR 1.4-9.3) years; 35% of children aged <5 years had a CD4 lymphocyte percentage <15% in 1997-2003, which fell to 15% of children in 2011 onwards (p < 0.001). Similarly, 53% and 18% of children ≥5 years had a CD4 count <200 cells/mm3 in 1997-2003 and in 2011 onwards, respectively (p < 0.001). Median follow-up was 5.6 (2.9-8.7) years. Of 94 deaths and 237 first AIDS-defining events, 43 (46%) and 100 (42%) were within 6 months of initiating cART, respectively. Multivariable predictors of early death were: being in the first year of life; residence in Russia, Ukraine, or Thailand; AIDS at cART start; initiating cART on a nonnucleoside reverse transcriptase inhibitor (NNRTI)-based regimen; severe immune suppression; and low BMI-for-age z-score. Current severe immune suppression, low current BMI-for-age z-score, and current viral load >400 c/mL predicted late death. Predictors of early and late progression to AIDS were similar. Study limitations include incomplete recording of US Centers for Disease Control (CDC) disease stage B events and serious adverse events in some countries; events that were distributed over a long time period, and that we lacked power to analyse trends in patterns and causes of death over time. Conclusions: In our study, 3,526 children and adolescents with perinatal HIV infection initiated antiretroviral therapy (ART) in countries in Europe and Thailand. We observed that over 40% of deaths occurred ≤6 months after cART initiation. Greater early mortality risk in infants, as compared to older children, and in Russia, Ukraine, or Thailand as compared to W&CE, raises concern. Current severe immune suppression, being underweight, and unsuppressed viral load were associated with a higher risk of death at >6 months after initiation of cART.
Note: Reproducció del document publicat a: https://doi.org/10.1371/journal.pmed.1002491
It is part of: PLoS Medicine, 2018, vol. 15, num. 1, p. e1002491
URI: http://hdl.handle.net/2445/157097
Related resource: https://doi.org/10.1371/journal.pmed.1002491
ISSN: 1549-1277
Appears in Collections:Articles publicats en revistes (Cirurgia i Especialitats Medicoquirúrgiques)

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