Outcomes of Antiretroviral Therapy in Children in Asia and Africa

• DOI: 10.1097/qai.0b013e31827b70bf
• Publication Date: 2012-11-29T09:06:59Z
• Authors: Valeriane Leroy; Karen Malateste; Helena Rabie; Pagakrong Lumbiganon; Samuel Ayaya; Fatoumata Dicko; Mary-Ann Davies; Azar Kariminia; Kara Wools-Kalous...; Edmond Aka; Samuel Phiri; Linda Aurpibul; Constantin Yianno...; Haby Signaté-Sy; Lynne Mofenson; François Dabis
• Keywords: Male; Asia; Adolescent; International Cooperation; HIV Infections; Africa, Southern; Cohort Studies; 03 medical and health sciences; 0302 clinical medicine; Humans; Child; Developing Countries; 1. No poverty; Age Factors; Infant; HIV Protease Inhibitors; Africa, Eastern; 3. Good health; CD4 Lymphocyte Count; Africa, Western; Anti-Retroviral Agents; Child, Preschool; Female; Lost to Follow-Up

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.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).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.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.