High Mortality Following Early Initiation of Antiretroviral Therapy in Infants Living with HIV from Three African Countries

• DOI: 10.2139/ssrn.4610012
• Publication Date: 2023-11-01T16:14:18Z
• Authors: Alfredo Tagarro; Sara Domínguez-Ro...; Mark F. Cotton; Kennedy Otwombe; Nigel Klein; Maria Grazia Lain; Tacilta Nhampossa; Almoustapha Issi...; Shaun L. Barnabas; Paula Vaz; Avy Violari; Sheila Fernandez-...; Osee Behuhuma; Ligia Estevao; Mariam Sillah; Elisa Lopez Varela; Denise Naniche; Anita Janse-Van-R...; Afaaf Liberty; Nastassja Ramsagar; Theresa Smit; Senamile Makhari; Nalia Ismael; Carlo Giaquinto; Paolo Rossi; Louise Kuhn; Paolo Palma; Moira J. Spyer; Matthias Lichterfeld; Eleni Nastouli; Viviana Gianuzzi; Álvaro Ballesteros; Nicola Cotugno; Elena Morrocchi; Andrea Oletto; Fatoumata Tata Tr...; Els Dobbels; Yasmeen Akhalwaya; Gregory Ording-Je...; Caroline Foster; Helena Rabie; Pauline Amuge; Camille Brehin; Savita Pahwa; Yacouba Aba Coul...; Pablo Rojo; EPIICAL Consortium

Background: Even with increasing access to rapid HIV diagnosis and early ART initiation, HIV-infected infants seem have adverse treatment outcomes. To assess the probability of death, viral suppression, other HIV-related events, we describe outcomes within first three years life among early-treated children perinatally acquired in South Africa, Mozambique, Mali.Methods: We enrolled a cohort who initiated antiretroviral therapy (ART) initial 6 months 3 diagnosis. These were monitored 2, 6, 12 24 weeks after enrolment, followed by biannual check-ups up 4 years. assessed load (VL) severe immunosuppression, healthcare engagement, using Cox multivariable regression models.Findings: Two hundred fifteen for 34 [IQR, 16·3; 44·1]. Anti-retroviral initiation occurred at median days age 26·0; 73·0]. The death year was 10% (95% CI 6-14) increased 12% CI, 8-17) both 2 Risk factors mortality included high baseline VL [HR: 95% CI], region CD4 percentage slope CI]. Sixty-one 146 (41·8%) achieved sustained virological suppression >1 year. Lack associated maternal social events. Assessment adherence considered optimal 81% visits. Female sex birth, lower events risk low adherence.Interpretation: Despite therapy, remains infants. High environment poor Sustained supportive strategies are essential during pregnancy, achieve better survival.Funding: Early Treated Perinatally Infected Individuals: Improving Children's Actual Life (EPIICAL) is research consortium funded ViiV Healthcare led Penta Foundation.Declaration Interest: No confits interest me rest Mali team. All authors nothing declare. Ethical Approval: independent Ethics Institutional review boards all participating institutions Countries approved study. Written informed consent from caregivers/legal representatives obtained.